{"text_format":"1","workbook":"xlsx","n_sheets":20,"sheets":["REVISION_HISTORY","WELCOME","MULTIPLE_PLAN_MODE","BENEFIT_DESIGN","BENEFIT_DESIGN_ERRORS","BENEFIT_PARAMETERS","RESULTS_SUMMARY","EXAMPLE_SUMMARY","DIABETES_SUMMARY","DIABETES_TIMELINE","DIABETES_LINE_ITEM","MATERNITY_SUMMARY","MATERNITY_TIMELINE","MATERNITY_LINE_ITEM","FRACTURE_SUMMARY","FRACTURE_TIMELINE","FRACTURE_LINE_ITEM","PLAN_INPUT_DATA","PLAN_OUTPUT_DATA","TimelineDocumentation"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":167,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"REVISION_HISTORY","index":0,"n_rows":32,"n_cols":5,"rows_kept":32,"cut":false,"hidden":true,"merged":[]}
["VERSION","DATE","PURPOSE OF REVISIONS","WORKSHEETS AFFECTED","CHANGES"]
["2.01","2015-11-23","Beta Release of Version 2","MANUAL_INPUT","Added 6 benefit options"]
[null,null,null,null,"Added 2 optional deductibles"]
[null,null,null,null,"Added 3 additional benefit categories"]
[null,null,null,"BENEFIT_DESIGN_ERRORS","Revised to accommodate additional benefit options and benefit categories"]
[null,null,null,"BENEFIT_DESIGN","Revised to accommodate additional benefit options and benefit categories"]
[null,null,null,"_LINE_ITEM","Replaced with revised schedule of services"]
[null,null,null,"_TIMELINE","Replaced with revised timelines"]
[null,null,null,"PLAN_INPUT_DATA","Revised to accommodate additional deductible options and benefit categories"]
["2.02","2015-11-24","Add maternity line items","MATERNITY_LINE_ITEM","Add normal vaginal delivery codes (not bundled)"]
[null,null,null,null,"Set office visit components of bundle (item 32, 33) to zero."]
["2.03","2015-11-24","Technical corrections","DIABETES_LINE_ITEM","Change benefit category for insulin to brand drug"]
[null,null,null,"RESULTS_SUMMARY","Diabetes subscriber payment"]
[null,null,null,"RESULTS_SUMMARY","Foot fracture subscriber payment"]
["2.04","2016-01-31","Rename worksheets","MANUAL_INPUT","Changed to BENEFIT_DESIGN"]
[null,null,"Increase benefit categories","BENEFIT_DESIGN","Increased the number of benefit categories to 20"]
[null,null,null,"BENEFIT_DESIGN_ERRORS","Increased the number of benefit categories to 20"]
[null,null,null,"BENEFIT_PARAMETERS","Increased the number of benefit categories to 20"]
[null,null,null,"MATERNITY_SUMMARY","Increased the number of benefit categories to 20"]
[null,null,null,"DIABETES_SUMMARY","Increased the number of benefit categories to 20"]
[null,null,null,"FRACTURE_SUMMARY","Increased the number of benefit categories to 20"]
[null,null,"Prompt to save changed parameters","BENEFIT_DESIGN","Added prompt to save changed parameters before navigating to next or"]
[null,null,null,null,"previous plan"]
[null,null,"Update plan count","BENEFIT_DESIGN","Update total plan count when new plan is added"]
["2.05","2016-02-19","Update ICD-9 diagnosis codes","MATERNITY_LINE_ITEM","Update to ICD-10 diagnosis codes"]
[null,null,null,"DIABETES_LINE_ITEM","Update to ICD-10 diagnosis codes"]
[null,null,null,"FRACTURE_LINE_ITEM","Update to ICD-10 diagnosis codes "]
[null,null,"Remove unused line-items","FRACTURE_LINE_ITEM","Remove line-items that are not used in timeline"]
[null,null,"Change button labels","RESULTS_SUMMARY","Change all buttons for examples to have consistent labels"]
["2.06","2016-02-22","Correction","FRACTURE_LINE_ITEM","Change column B heading to reference ICD-10"]
[null,null,null,"DIABETES_LINE_ITEM","Change column B heading to reference ICD-10"]
[null,null,null,"MATERNITY_LINE_ITEM","Change column B heading to reference ICD-10"]

{"sheet":"WELCOME","index":1,"n_rows":14,"n_cols":4,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Welcome to the Coverage Examples Cost Sharing Calculator"]
[]
[null,"All insurer data entry fields are highlighted in orange."]
[]
[null,"The Cost Sharing Calculator operates in two modes."]
[null,"Click the button that corresponds to the mode you want to use."]
[]
[null,null,null,"The user enters data for an individual plan and views the results."]
[]
[null,null,null,"The user loads data for multiple plans and runs the calculator."]
[null,null,null,"The user can then browse the results for the individual plans, save"]
[null,null,null,"the results to an external file, or copy and paste the results for "]
[null,null,null,"the individual plans to a separate worksheet."]

{"sheet":"MULTIPLE_PLAN_MODE","index":2,"n_rows":20,"n_cols":4,"rows_kept":20,"cut":false,"hidden":true,"merged":[]}
[]
[null,"Multiple Plan Mode"]
[null,null,"In multiple plan mode you load data for multiple plans into the calculator."]
[null,null,"The calculator will check your plan benefit design data for errors and calculate"]
[null,null,"subscriber cost sharing for each plan."]
[null,null,"After loading plan data you can browse the output and review the benefit design"]
[null,null,"parameters for each plan. You can also correct any errors that were identfied"]
[null,null,"and update your input data by switching to Single Plan Mode."]
[]
[]
[null,"You have three options for loading plan-level data."]
[null,"Select the option you want to use by clicking the appropriate button."]
[]
[null,null,"Import data from external file."]
[]
[null,"Option 2: ","Copy and paste data from an external file into the plan input data worksheet."]
[]
[null,"Option 3:","Enter data for each plan in Single Plan Mode and save the data to the input data worksheet."]
[]
[null,null,null,"Click the button to the left to switch to Single Plan Mode"]

{"sheet":"BENEFIT_DESIGN","index":3,"n_rows":34,"n_cols":31,"rows_kept":34,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Single Plan Mode",null,null,{"$f":"$Y$3&\" of \"&$Y$2","v":"3 of 3"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Total plan count:",3]
[null,"Enter or modify data for each plan. ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Current plan:",3]
[null,"Data entry fields are highlighted in orange.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Parameters Changed?",true]
[]
[null,"Plan 3",null,"Cost sharing¹",null,null,"Coverage Limits",null,"OOP",null,null,"Coverage parameters allowed",null,null,null,null,null,null,null,null,null,null,null,"Coverage Options Table"]
[null,"Benefit category","Type of cost sharing that applies","Benefit Deductible","Co-payment","Co-insurance","per month","per year","limit applies?",null,null,"Allowed Coverage type?","Uses plan deductible","Uses Rx deductible","Uses deductible C","Uses deductible D","Uses benefit deductible","Uses copayment","Uses coinsurance","Monthly limits allowed?","Annual Limits allowed?","OOP limit applies?",null,"Cost sharing description","Uses plan deductible","Uses Rx deductible","Uses deductible C","Uses deductible D","Uses benefit deductible","Uses copayment","Uses coinsurance"]
[null,"Inpatient Hospital Care (Facility)","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,{"$f":"IFERROR(IF(MATCH($C8,$X$8:$X$26,0)>0,TRUE,FALSE),FALSE)","v":true},{"$f":"IFERROR(VLOOKUP($C8,$X$8:$AE$26,MATCH(M$7,$X$7:$AE$7,0),FALSE),FALSE)","v":true},false,false,false,false,false,false,{"$f":"IFERROR(IF(MATCH($C8,$X$8:$X$26,0)>1,TRUE,FALSE),FALSE)","v":true},{"$f":"$T8","v":true},true,null,"Not Covered",false,false,false,false,false,false,false]
[null,"Other Facility Services","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,true,false,false,false,false,false,false,true,true,true,null,"No Cost Sharing",false,false,false,false,false,false,false]
[null,"Emergency Department (Facility)","Deductible C Only",null,null,null,"None","None","Yes",null,null,true,false,false,true,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$28&\" Only\"","v":"Plan Deductible Only"},true,false,false,false,false,false,false]
[null,"Ambulance","Deductible C Only",null,null,null,"None","None","Yes",null,null,true,false,false,true,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$29&\" Only\"","v":"Rx Deductible Only"},false,true,false,false,false,false,false]
[null,"Professional Services: Primary Care","Copayment Only",null,30,null,"None","None","Yes",null,null,true,false,false,false,false,false,true,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$30&\" Only\"","v":"Deductible C Only"},false,false,true,false,false,false,false]
[null,"Professional Services: Emergency Department","Deductible C Only",null,null,null,"None","None","Yes",null,null,true,false,false,true,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$31&\" Only\"","v":"Deductible D Only"},false,false,false,true,false,false,false]
[null,"Professional Services: Specialist","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,true,false,false,false,false,false,false,true,true,true,null,"Benefit Deductible Only",false,false,false,false,true,false,false]
[null,"Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,true,false,false,false,false,false,false,true,true,true,null,"Copayment Only",false,false,false,false,false,true,false]
[null,"Professional Services: Procedures & Other","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,true,false,false,false,false,false,false,true,true,true,null,"Coinsurance Only",false,false,false,false,false,false,true]
[null,"Professional Services: Physical Therapy","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,true,false,false,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$28&\"+Co-pay\"","v":"Plan Deductible+Co-pay"},true,false,false,false,false,true,false]
[null,"Diagnostic Services: Radiology","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,{"$f":"IFERROR(VLOOKUP($C18,$X$8:$AE$26,MATCH(M$7,$X$7:$AE$7,0),FALSE),FALSE)","v":true},false,false,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$29&\"+Co-pay\"","v":"Rx Deductible+Co-pay"},false,true,false,false,false,true,false]
[null,"Diagnostic Services: Laboratory","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,true,false,false,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$30&\"+Co-pay\"","v":"Deductible C+Co-pay"},false,false,true,false,false,true,false]
[null,"Prescription Drugs: Generic","Rx Deductible+Co-ins",null,null,0.1,"None","None","Yes",null,null,true,false,true,false,false,false,false,true,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$31&\"+Co-pay\"","v":"Deductible D+Co-pay"},false,false,false,true,false,true,false]
[null,"Prescription Drugs: Branded","Rx Deductible+Co-pay",null,30,null,"None","None","Yes",null,null,true,false,true,false,false,false,true,false,true,true,true,null,"Benefit Deductible+Co-pay",false,false,false,false,true,true,false]
[null,"Over-the-counter Drugs","Not Covered",null,null,null,null,null,null,null,null,true,false,false,false,false,false,false,false,false,false,false,null,{"$f":"BENEFIT_DESIGN!$B$28&\"+Co-ins\"","v":"Plan Deductible+Co-ins"},true,false,false,false,false,false,true]
[null,"Preventive Services & Vaccines","No Cost Sharing",null,null,null,"None","None","Yes",null,null,true,false,false,false,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$29&\"+Co-ins\"","v":"Rx Deductible+Co-ins"},false,true,false,false,false,false,true]
[null,"Durable Medical Equipment","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,true,false,false,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$30&\"+Co-ins\"","v":"Deductible C+Co-ins"},false,false,true,false,false,false,true]
[null,"Medical Supplies","Plan Deductible Only",null,null,null,"None","None","Yes",null,null,true,true,false,false,false,false,false,false,true,true,true,null,{"$f":"BENEFIT_DESIGN!$B$31&\"+Co-ins\"","v":"Deductible D+Co-ins"},false,false,false,true,false,false,true]
[null,"Over-the-counter Medical Supplies","Not Covered",null,null,null,null,null,null,null,null,true,false,false,false,false,false,false,false,false,false,false,null,"Benefit Deductible+Co-ins",false,false,false,false,true,false,true]
[null,"Other Items & Services","Not Covered",null,null,null,null,null,null,null,null,true,false,false,false,false,false,false,false,false,false,false]
[null,"Plan Deductible",1000,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIF(M8:M27,TRUE)>0","v":true}]
[null,"Rx Deductible",100,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIF(N8:N27,TRUE)>0","v":true}]
[null,"Deductible C",500,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIF(O8:O27,TRUE)>0","v":true}]
[null,"Deductible D",null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIF(P8:P27,TRUE)>0","v":false}]
[null,"Individual Out-of-Pocket (OOP) Limit",1000,null,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"COUNTIF(V8:V27,TRUE)>0","v":true}]
[null,"¹ The benefit-specific deductible, copayment amount, or coinsurance rate that determines consumer liability."]
[null,"² Outpatient services include non-professional Emergency Department services. Professional services fall under the Professional Services benefit categories."]

{"sheet":"BENEFIT_DESIGN_ERRORS","index":4,"n_rows":34,"n_cols":20,"rows_kept":34,"cut":false,"hidden":true,"merged":[]}
[]
[]
[null,"Plan Design Errors"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Parameters specified in plan benefit design"]
[null,"Plan 2",null,null,null,null,null,"Cost sharing¹",null,null,"Coverage Limits",null,"OOP",null,"Cost sharing¹",null,null,"Coverage Limits"]
[null,"Benefit category","Coverage type","Plan Deductible","Rx Deductible","Deductible C","Deductible D","Benefit Deductible","Co-payment","Co-insurance","per month","per year","limit applies?",null,"Has benefit deductible","Has co-payment","Has co-insurance","Has monthly limit","Has annual limit","Has OOP limit"]
[null,{"$f":"BENEFIT_DESIGN!B8","v":"Inpatient Hospital Care (Facility)"},{"$f":"IF(BENEFIT_DESIGN!L8,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M8,IF(BENEFIT_PARAMETERS!C8=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C8=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N8,IF(BENEFIT_PARAMETERS!D8=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D8=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O8,IF(BENEFIT_PARAMETERS!E8=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E8=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P8,IF(BENEFIT_PARAMETERS!F8=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F8=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q8,IF(BENEFIT_PARAMETERS!H8=0,TRUE,FALSE),IF(O8,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R8,IF(BENEFIT_PARAMETERS!I8<=0,TRUE,FALSE),IF(P8,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S8,IF(BENEFIT_PARAMETERS!J8<=0,TRUE,FALSE),IF(Q8,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T8,IF(BENEFIT_PARAMETERS!K8=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K8>0,FALSE,TRUE)),IF(R8,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U8,IF(BENEFIT_PARAMETERS!L8=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L8>0,FALSE,TRUE)),IF(S8,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V8,IF(BENEFIT_PARAMETERS!M8=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M8=\"No\",FALSE,TRUE)),IF(T8,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D8)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E8)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F8)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G8)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H8)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I8)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B9","v":"Other Facility Services"},{"$f":"IF(BENEFIT_DESIGN!L9,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M9,IF(BENEFIT_PARAMETERS!C9=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C9=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N9,IF(BENEFIT_PARAMETERS!D9=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D9=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O9,IF(BENEFIT_PARAMETERS!E9=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E9=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P9,IF(BENEFIT_PARAMETERS!F9=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F9=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q9,IF(BENEFIT_PARAMETERS!H9=0,TRUE,FALSE),IF(O9,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R9,IF(BENEFIT_PARAMETERS!I9<=0,TRUE,FALSE),IF(P9,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S9,IF(BENEFIT_PARAMETERS!J9<=0,TRUE,FALSE),IF(Q9,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T9,IF(BENEFIT_PARAMETERS!K9=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K9>0,FALSE,TRUE)),IF(R9,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U9,IF(BENEFIT_PARAMETERS!L9=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L9>0,FALSE,TRUE)),IF(S9,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V9,IF(BENEFIT_PARAMETERS!M9=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M9=\"No\",FALSE,TRUE)),IF(T9,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D9)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E9)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F9)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G9)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H9)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I9)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B10","v":"Emergency Department (Facility)"},{"$f":"IF(BENEFIT_DESIGN!L10,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M10,IF(BENEFIT_PARAMETERS!C10=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C10=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N10,IF(BENEFIT_PARAMETERS!D10=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D10=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O10,IF(BENEFIT_PARAMETERS!E10=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E10=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P10,IF(BENEFIT_PARAMETERS!F10=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F10=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q10,IF(BENEFIT_PARAMETERS!H10=0,TRUE,FALSE),IF(O10,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R10,IF(BENEFIT_PARAMETERS!I10<=0,TRUE,FALSE),IF(P10,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S10,IF(BENEFIT_PARAMETERS!J10<=0,TRUE,FALSE),IF(Q10,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T10,IF(BENEFIT_PARAMETERS!K10=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K10>0,FALSE,TRUE)),IF(R10,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U10,IF(BENEFIT_PARAMETERS!L10=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L10>0,FALSE,TRUE)),IF(S10,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V10,IF(BENEFIT_PARAMETERS!M10=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M10=\"No\",FALSE,TRUE)),IF(T10,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D10)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E10)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F10)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G10)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H10)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I10)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B11","v":"Ambulance"},{"$f":"IF(BENEFIT_DESIGN!L11,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M11,IF(BENEFIT_PARAMETERS!C11=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C11=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N11,IF(BENEFIT_PARAMETERS!D11=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D11=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O11,IF(BENEFIT_PARAMETERS!E11=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E11=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P11,IF(BENEFIT_PARAMETERS!F11=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F11=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q11,IF(BENEFIT_PARAMETERS!H11=0,TRUE,FALSE),IF(O11,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R11,IF(BENEFIT_PARAMETERS!I11<=0,TRUE,FALSE),IF(P11,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S11,IF(BENEFIT_PARAMETERS!J11<=0,TRUE,FALSE),IF(Q11,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T11,IF(BENEFIT_PARAMETERS!K11=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K11>0,FALSE,TRUE)),IF(R11,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U11,IF(BENEFIT_PARAMETERS!L11=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L11>0,FALSE,TRUE)),IF(S11,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V11,IF(BENEFIT_PARAMETERS!M11=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M11=\"No\",FALSE,TRUE)),IF(T11,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D11)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E11)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F11)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G11)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H11)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I11)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B12","v":"Professional Services: Primary Care"},{"$f":"IF(BENEFIT_DESIGN!L12,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M12,IF(BENEFIT_PARAMETERS!C12=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C12=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N12,IF(BENEFIT_PARAMETERS!D12=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D12=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O12,IF(BENEFIT_PARAMETERS!E12=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E12=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P12,IF(BENEFIT_PARAMETERS!F12=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F12=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q12,IF(BENEFIT_PARAMETERS!H12=0,TRUE,FALSE),IF(O12,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R12,IF(BENEFIT_PARAMETERS!I12<=0,TRUE,FALSE),IF(P12,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S12,IF(BENEFIT_PARAMETERS!J12<=0,TRUE,FALSE),IF(Q12,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T12,IF(BENEFIT_PARAMETERS!K12=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K12>0,FALSE,TRUE)),IF(R12,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U12,IF(BENEFIT_PARAMETERS!L12=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L12>0,FALSE,TRUE)),IF(S12,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V12,IF(BENEFIT_PARAMETERS!M12=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M12=\"No\",FALSE,TRUE)),IF(T12,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D12)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E12)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!F12)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G12)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H12)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I12)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B13","v":"Professional Services: Emergency Department"},{"$f":"IF(BENEFIT_DESIGN!L13,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M13,IF(BENEFIT_PARAMETERS!C13=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C13=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N13,IF(BENEFIT_PARAMETERS!D13=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D13=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O13,IF(BENEFIT_PARAMETERS!E13=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E13=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P13,IF(BENEFIT_PARAMETERS!F13=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F13=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q13,IF(BENEFIT_PARAMETERS!H13=0,TRUE,FALSE),IF(O13,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R13,IF(BENEFIT_PARAMETERS!I13<=0,TRUE,FALSE),IF(P13,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S13,IF(BENEFIT_PARAMETERS!J13<=0,TRUE,FALSE),IF(Q13,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T13,IF(BENEFIT_PARAMETERS!K13=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K13>0,FALSE,TRUE)),IF(R13,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U13,IF(BENEFIT_PARAMETERS!L13=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L13>0,FALSE,TRUE)),IF(S13,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V13,IF(BENEFIT_PARAMETERS!M13=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M13=\"No\",FALSE,TRUE)),IF(T13,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D13)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E13)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F13)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G13)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H13)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I13)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B14","v":"Professional Services: Specialist"},{"$f":"IF(BENEFIT_DESIGN!L14,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M14,IF(BENEFIT_PARAMETERS!C14=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C14=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N14,IF(BENEFIT_PARAMETERS!D14=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D14=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O14,IF(BENEFIT_PARAMETERS!E14=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E14=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P14,IF(BENEFIT_PARAMETERS!F14=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F14=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q14,IF(BENEFIT_PARAMETERS!H14=0,TRUE,FALSE),IF(O14,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R14,IF(BENEFIT_PARAMETERS!I14<=0,TRUE,FALSE),IF(P14,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S14,IF(BENEFIT_PARAMETERS!J14<=0,TRUE,FALSE),IF(Q14,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T14,IF(BENEFIT_PARAMETERS!K14=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K14>0,FALSE,TRUE)),IF(R14,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U14,IF(BENEFIT_PARAMETERS!L14=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L14>0,FALSE,TRUE)),IF(S14,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V14,IF(BENEFIT_PARAMETERS!M14=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M14=\"No\",FALSE,TRUE)),IF(T14,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D14)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E14)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F14)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G14)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H14)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I14)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B15","v":"Professional Services: Obstetric Care (Bundled)"},{"$f":"IF(BENEFIT_DESIGN!L15,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M15,IF(BENEFIT_PARAMETERS!C15=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C15=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N15,IF(BENEFIT_PARAMETERS!D15=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D15=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O15,IF(BENEFIT_PARAMETERS!E15=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E15=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P15,IF(BENEFIT_PARAMETERS!F15=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F15=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q15,IF(BENEFIT_PARAMETERS!H15=0,TRUE,FALSE),IF(O15,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R15,IF(BENEFIT_PARAMETERS!I15<=0,TRUE,FALSE),IF(P15,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S15,IF(BENEFIT_PARAMETERS!J15<=0,TRUE,FALSE),IF(Q15,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T15,IF(BENEFIT_PARAMETERS!K15=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K15>0,FALSE,TRUE)),IF(R15,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U15,IF(BENEFIT_PARAMETERS!L15=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L15>0,FALSE,TRUE)),IF(S15,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V15,IF(BENEFIT_PARAMETERS!M15=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M15=\"No\",FALSE,TRUE)),IF(T15,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D15)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E15)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F15)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G15)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H15)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I15)","v":false}]
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[null,{"$f":"BENEFIT_DESIGN!B19","v":"Diagnostic Services: Laboratory"},{"$f":"IF(BENEFIT_DESIGN!L19,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M19,IF(BENEFIT_PARAMETERS!C19=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C19=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N19,IF(BENEFIT_PARAMETERS!D19=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D19=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O19,IF(BENEFIT_PARAMETERS!E19=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E19=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P19,IF(BENEFIT_PARAMETERS!F19=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F19=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q19,IF(BENEFIT_PARAMETERS!H19=0,TRUE,FALSE),IF(O19,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R19,IF(BENEFIT_PARAMETERS!I19<=0,TRUE,FALSE),IF(P19,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S19,IF(BENEFIT_PARAMETERS!J19<=0,TRUE,FALSE),IF(Q19,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T19,IF(BENEFIT_PARAMETERS!K19=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K19>0,FALSE,TRUE)),IF(R19,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U19,IF(BENEFIT_PARAMETERS!L19=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L19>0,FALSE,TRUE)),IF(S19,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V19,IF(BENEFIT_PARAMETERS!M19=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M19=\"No\",FALSE,TRUE)),IF(T19,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D19)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E19)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F19)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G19)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H19)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I19)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B20","v":"Prescription Drugs: Generic"},{"$f":"IF(BENEFIT_DESIGN!L20,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M20,IF(BENEFIT_PARAMETERS!C20=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C20=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N20,IF(BENEFIT_PARAMETERS!D20=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D20=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O20,IF(BENEFIT_PARAMETERS!E20=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E20=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P20,IF(BENEFIT_PARAMETERS!F20=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F20=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q20,IF(BENEFIT_PARAMETERS!H20=0,TRUE,FALSE),IF(O20,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R20,IF(BENEFIT_PARAMETERS!I20<=0,TRUE,FALSE),IF(P20,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S20,IF(BENEFIT_PARAMETERS!J20<=0,TRUE,FALSE),IF(Q20,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T20,IF(BENEFIT_PARAMETERS!K20=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K20>0,FALSE,TRUE)),IF(R20,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U20,IF(BENEFIT_PARAMETERS!L20=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L20>0,FALSE,TRUE)),IF(S20,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V20,IF(BENEFIT_PARAMETERS!M20=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M20=\"No\",FALSE,TRUE)),IF(T20,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D20)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E20)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F20)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!G20)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H20)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I20)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B21","v":"Prescription Drugs: Branded"},{"$f":"IF(BENEFIT_DESIGN!L21,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M21,IF(BENEFIT_PARAMETERS!C21=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C21=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N21,IF(BENEFIT_PARAMETERS!D21=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D21=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O21,IF(BENEFIT_PARAMETERS!E21=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E21=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P21,IF(BENEFIT_PARAMETERS!F21=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F21=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q21,IF(BENEFIT_PARAMETERS!H21=0,TRUE,FALSE),IF(O21,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R21,IF(BENEFIT_PARAMETERS!I21<=0,TRUE,FALSE),IF(P21,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S21,IF(BENEFIT_PARAMETERS!J21<=0,TRUE,FALSE),IF(Q21,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T21,IF(BENEFIT_PARAMETERS!K21=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K21>0,FALSE,TRUE)),IF(R21,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U21,IF(BENEFIT_PARAMETERS!L21=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L21>0,FALSE,TRUE)),IF(S21,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V21,IF(BENEFIT_PARAMETERS!M21=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M21=\"No\",FALSE,TRUE)),IF(T21,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D21)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E21)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!F21)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G21)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H21)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I21)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B22","v":"Over-the-counter Drugs"},{"$f":"IF(BENEFIT_DESIGN!L22,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M22,IF(BENEFIT_PARAMETERS!C22=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C22=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N22,IF(BENEFIT_PARAMETERS!D22=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D22=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O22,IF(BENEFIT_PARAMETERS!E22=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E22=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P22,IF(BENEFIT_PARAMETERS!F22=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F22=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q22,IF(BENEFIT_PARAMETERS!H22=0,TRUE,FALSE),IF(O22,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R22,IF(BENEFIT_PARAMETERS!I22<=0,TRUE,FALSE),IF(P22,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S22,IF(BENEFIT_PARAMETERS!J22<=0,TRUE,FALSE),IF(Q22,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T22,IF(BENEFIT_PARAMETERS!K22=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K22>0,FALSE,TRUE)),IF(R22,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U22,IF(BENEFIT_PARAMETERS!L22=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L22>0,FALSE,TRUE)),IF(S22,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V22,IF(BENEFIT_PARAMETERS!M22=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M22=\"No\",FALSE,TRUE)),IF(T22,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D22)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E22)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F22)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G22)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!H22)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!I22)","v":true}]
[null,{"$f":"BENEFIT_DESIGN!B23","v":"Preventive Services & Vaccines"},{"$f":"IF(BENEFIT_DESIGN!L23,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M23,IF(BENEFIT_PARAMETERS!C23=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C23=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N23,IF(BENEFIT_PARAMETERS!D23=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D23=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O23,IF(BENEFIT_PARAMETERS!E23=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E23=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P23,IF(BENEFIT_PARAMETERS!F23=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F23=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q23,IF(BENEFIT_PARAMETERS!H23=0,TRUE,FALSE),IF(O23,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R23,IF(BENEFIT_PARAMETERS!I23<=0,TRUE,FALSE),IF(P23,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S23,IF(BENEFIT_PARAMETERS!J23<=0,TRUE,FALSE),IF(Q23,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T23,IF(BENEFIT_PARAMETERS!K23=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K23>0,FALSE,TRUE)),IF(R23,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U23,IF(BENEFIT_PARAMETERS!L23=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L23>0,FALSE,TRUE)),IF(S23,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V23,IF(BENEFIT_PARAMETERS!M23=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M23=\"No\",FALSE,TRUE)),IF(T23,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D23)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E23)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F23)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G23)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H23)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I23)","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B24","v":"Durable Medical Equipment"},{"$f":"IF(BENEFIT_DESIGN!L24,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M24,IF(BENEFIT_PARAMETERS!C24=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C24=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N24,IF(BENEFIT_PARAMETERS!D24=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D24=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O24,IF(BENEFIT_PARAMETERS!E24=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E24=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P24,IF(BENEFIT_PARAMETERS!F24=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F24=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q24,IF(BENEFIT_PARAMETERS!H24=0,TRUE,FALSE),IF(O24,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R24,IF(BENEFIT_PARAMETERS!I24<=0,TRUE,FALSE),IF(P24,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S24,IF(BENEFIT_PARAMETERS!J24<=0,TRUE,FALSE),IF(Q24,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T24,IF(BENEFIT_PARAMETERS!K24=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K24>0,FALSE,TRUE)),IF(R24,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U24,IF(BENEFIT_PARAMETERS!L24=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L24>0,FALSE,TRUE)),IF(S24,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V24,IF(BENEFIT_PARAMETERS!M24=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M24=\"No\",FALSE,TRUE)),IF(T24,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D24)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E24)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F24)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G24)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!H24)","v":false},{"$f":"ISBLANK(BENEFIT_DESIGN!I24)","v":false}]
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[null,{"$f":"BENEFIT_DESIGN!B26","v":"Over-the-counter Medical Supplies"},{"$f":"IF(BENEFIT_DESIGN!L26,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M26,IF(BENEFIT_PARAMETERS!C26=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C26=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N26,IF(BENEFIT_PARAMETERS!D26=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D26=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O26,IF(BENEFIT_PARAMETERS!E26=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E26=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P26,IF(BENEFIT_PARAMETERS!F26=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F26=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q26,IF(BENEFIT_PARAMETERS!H26=0,TRUE,FALSE),IF(O26,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R26,IF(BENEFIT_PARAMETERS!I26<=0,TRUE,FALSE),IF(P26,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S26,IF(BENEFIT_PARAMETERS!J26<=0,TRUE,FALSE),IF(Q26,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T26,IF(BENEFIT_PARAMETERS!K26=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K26>0,FALSE,TRUE)),IF(R26,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U26,IF(BENEFIT_PARAMETERS!L26=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L26>0,FALSE,TRUE)),IF(S26,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V26,IF(BENEFIT_PARAMETERS!M26=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M26=\"No\",FALSE,TRUE)),IF(T26,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D26)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E26)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F26)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G26)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!H26)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!I26)","v":true}]
[null,{"$f":"BENEFIT_DESIGN!B27","v":"Other Items & Services"},{"$f":"IF(BENEFIT_DESIGN!L27,FALSE,TRUE)","v":false},{"$f":"IFERROR(IF(BENEFIT_DESIGN!M27,IF(BENEFIT_PARAMETERS!C27=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!C27=0,FALSE,TRUE)),TRUE)","v":false},{"$f":"IF(BENEFIT_DESIGN!N27,IF(BENEFIT_PARAMETERS!D27=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!D27=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!O27,IF(BENEFIT_PARAMETERS!E27=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!E27=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!P27,IF(BENEFIT_PARAMETERS!F27=0,TRUE,FALSE),IF(BENEFIT_PARAMETERS!F27=0,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!Q27,IF(BENEFIT_PARAMETERS!H27=0,TRUE,FALSE),IF(O27,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!R27,IF(BENEFIT_PARAMETERS!I27<=0,TRUE,FALSE),IF(P27,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!S27,IF(BENEFIT_PARAMETERS!J27<=0,TRUE,FALSE),IF(Q27,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!T27,IF(BENEFIT_PARAMETERS!K27=\"None\",FALSE,IF(BENEFIT_PARAMETERS!K27>0,FALSE,TRUE)),IF(R27,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!U27,IF(BENEFIT_PARAMETERS!L27=\"None\",FALSE,IF(BENEFIT_PARAMETERS!L27>0,FALSE,TRUE)),IF(S27,FALSE,TRUE))","v":false},{"$f":"IF(BENEFIT_DESIGN!V27,IF(BENEFIT_PARAMETERS!M27=\"Yes\",FALSE,IF(BENEFIT_PARAMETERS!M27=\"No\",FALSE,TRUE)),IF(T27,FALSE,TRUE))","v":false},null,{"$f":"ISBLANK(BENEFIT_DESIGN!D27)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!E27)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!F27)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!G27)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!H27)","v":true},{"$f":"ISBLANK(BENEFIT_DESIGN!I27)","v":true}]
[null,{"$f":"BENEFIT_DESIGN!B28","v":"Plan Deductible"},{"$f":"IF(BENEFIT_DESIGN!M28,IF(BENEFIT_DESIGN!C28>0,FALSE,TRUE),IF(ISBLANK(BENEFIT_DESIGN!C28),FALSE,TRUE))","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B29","v":"Rx Deductible"},{"$f":"IF(BENEFIT_DESIGN!N29,IF(BENEFIT_DESIGN!C29>0,FALSE,TRUE),IF(ISBLANK(BENEFIT_DESIGN!C29),FALSE,TRUE))","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B30","v":"Deductible C"},{"$f":"IF(BENEFIT_DESIGN!O30,IF(BENEFIT_DESIGN!C30>0,FALSE,TRUE),IF(ISBLANK(BENEFIT_DESIGN!C30),FALSE,TRUE))","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B31","v":"Deductible D"},{"$f":"IF(BENEFIT_DESIGN!P31,IF(BENEFIT_DESIGN!C31>0,FALSE,TRUE),IF(ISBLANK(BENEFIT_DESIGN!C31),FALSE,TRUE))","v":false}]
[null,{"$f":"BENEFIT_DESIGN!B32","v":"Individual Out-of-Pocket (OOP) Limit"},{"$f":"IF(BENEFIT_DESIGN!V32,IF(BENEFIT_DESIGN!C32>0,FALSE,TRUE),IF(ISBLANK(BENEFIT_DESIGN!C32),FALSE,TRUE))","v":false},null,null,null,null,null,0,null,null,null,null,null,null,0]
[]
[null,"Errors exist",{"$f":"IF(COUNTIF(C8:M32,TRUE)=0,FALSE,TRUE)","v":false},{"$f":"IF(COUNTIF(D8:D27,TRUE)=0,FALSE,TRUE)","v":false},{"$f":"IF(COUNTIF(E8:E27,TRUE)=0,FALSE,TRUE)","v":false},false,false,false,false,false,false,false,false,null,null,0]

{"sheet":"BENEFIT_PARAMETERS","index":5,"n_rows":27,"n_cols":13,"rows_kept":27,"cut":false,"hidden":true,"merged":[]}
[]
[]
["Plan Parameters"]
[]
[]
[]
["Benefit category","Cost Sharing Type","Plan deductible","Rx deductible","Optional Deductible C","Optional Deductible D","Out of Pocket Limit","Benefit deductible","Copayment","Coinsurance","Coverage Limit per Month","Coverage Limit per Year","OOP limit applies"]
[{"$f":"BENEFIT_DESIGN!B8","v":"Inpatient Hospital Care (Facility)"},{"$f":"BENEFIT_DESIGN!C8","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M8,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N8,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O8,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P8,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V8,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q8,BENEFIT_DESIGN!D8,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R8,BENEFIT_DESIGN!E8,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S8,BENEFIT_DESIGN!F8,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G8=0,\"None\",BENEFIT_DESIGN!G8)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H8=0,\"None\",BENEFIT_DESIGN!H8)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I8=0,\"None\",BENEFIT_DESIGN!I8)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B9","v":"Other Facility Services"},{"$f":"BENEFIT_DESIGN!C9","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M9,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N9,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O9,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P9,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V9,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q9,BENEFIT_DESIGN!D9,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R9,BENEFIT_DESIGN!E9,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S9,BENEFIT_DESIGN!F9,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G9=0,\"None\",BENEFIT_DESIGN!G9)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H9=0,\"None\",BENEFIT_DESIGN!H9)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I9=0,\"None\",BENEFIT_DESIGN!I9)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B10","v":"Emergency Department (Facility)"},{"$f":"BENEFIT_DESIGN!C10","v":"Deductible C Only"},{"$f":"IF(BENEFIT_DESIGN!M10,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N10,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O10,BENEFIT_DESIGN!$C$29,0)","v":100},{"$f":"IF(BENEFIT_DESIGN!P10,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V10,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q10,BENEFIT_DESIGN!D10,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R10,BENEFIT_DESIGN!E10,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S10,BENEFIT_DESIGN!F10,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G10=0,\"None\",BENEFIT_DESIGN!G10)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H10=0,\"None\",BENEFIT_DESIGN!H10)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I10=0,\"None\",BENEFIT_DESIGN!I10)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B11","v":"Ambulance"},{"$f":"BENEFIT_DESIGN!C11","v":"Deductible C Only"},{"$f":"IF(BENEFIT_DESIGN!M11,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N11,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O11,BENEFIT_DESIGN!$C$29,0)","v":100},{"$f":"IF(BENEFIT_DESIGN!P11,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V11,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q11,BENEFIT_DESIGN!D11,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R11,BENEFIT_DESIGN!E11,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S11,BENEFIT_DESIGN!F11,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G11=0,\"None\",BENEFIT_DESIGN!G11)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H11=0,\"None\",BENEFIT_DESIGN!H11)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I11=0,\"None\",BENEFIT_DESIGN!I11)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B12","v":"Professional Services: Primary Care"},{"$f":"BENEFIT_DESIGN!C12","v":"Copayment Only"},{"$f":"IF(BENEFIT_DESIGN!M12,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N12,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O12,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P12,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V12,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q12,BENEFIT_DESIGN!D12,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R12,BENEFIT_DESIGN!E12,0)","v":30},{"$f":"IF(BENEFIT_DESIGN!S12,BENEFIT_DESIGN!F12,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G12=0,\"None\",BENEFIT_DESIGN!G12)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H12=0,\"None\",BENEFIT_DESIGN!H12)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I12=0,\"None\",BENEFIT_DESIGN!I12)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B13","v":"Professional Services: Emergency Department"},{"$f":"BENEFIT_DESIGN!C13","v":"Deductible C Only"},{"$f":"IF(BENEFIT_DESIGN!M13,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N13,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O13,BENEFIT_DESIGN!$C$29,0)","v":100},{"$f":"IF(BENEFIT_DESIGN!P13,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V13,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q13,BENEFIT_DESIGN!D13,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R13,BENEFIT_DESIGN!E13,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S13,BENEFIT_DESIGN!F13,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G13=0,\"None\",BENEFIT_DESIGN!G13)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H13=0,\"None\",BENEFIT_DESIGN!H13)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I13=0,\"None\",BENEFIT_DESIGN!I13)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B14","v":"Professional Services: Specialist"},{"$f":"BENEFIT_DESIGN!C14","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M14,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N14,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O14,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P14,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V14,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q14,BENEFIT_DESIGN!D14,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R14,BENEFIT_DESIGN!E14,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S14,BENEFIT_DESIGN!F14,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G14=0,\"None\",BENEFIT_DESIGN!G14)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H14=0,\"None\",BENEFIT_DESIGN!H14)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I14=0,\"None\",BENEFIT_DESIGN!I14)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B15","v":"Professional Services: Obstetric Care (Bundled)"},{"$f":"BENEFIT_DESIGN!C15","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M15,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N15,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O15,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P15,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V15,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q15,BENEFIT_DESIGN!D15,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R15,BENEFIT_DESIGN!E15,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S15,BENEFIT_DESIGN!F15,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G15=0,\"None\",BENEFIT_DESIGN!G15)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H15=0,\"None\",BENEFIT_DESIGN!H15)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I15=0,\"None\",BENEFIT_DESIGN!I15)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B16","v":"Professional Services: Procedures & Other"},{"$f":"BENEFIT_DESIGN!C16","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M16,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N16,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O16,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P16,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V16,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q16,BENEFIT_DESIGN!D16,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R16,BENEFIT_DESIGN!E16,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S16,BENEFIT_DESIGN!F16,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G16=0,\"None\",BENEFIT_DESIGN!G16)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H16=0,\"None\",BENEFIT_DESIGN!H16)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I16=0,\"None\",BENEFIT_DESIGN!I16)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B17","v":"Professional Services: Physical Therapy"},{"$f":"BENEFIT_DESIGN!C17","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M17,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N17,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O17,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P17,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V17,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q17,BENEFIT_DESIGN!D17,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R17,BENEFIT_DESIGN!E17,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S17,BENEFIT_DESIGN!F17,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G17=0,\"None\",BENEFIT_DESIGN!G17)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H17=0,\"None\",BENEFIT_DESIGN!H17)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I17=0,\"None\",BENEFIT_DESIGN!I17)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B18","v":"Diagnostic Services: Radiology"},{"$f":"BENEFIT_DESIGN!C18","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M18,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N18,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O18,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P18,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V18,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q18,BENEFIT_DESIGN!D18,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R18,BENEFIT_DESIGN!E18,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S18,BENEFIT_DESIGN!F18,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G18=0,\"None\",BENEFIT_DESIGN!G18)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H18=0,\"None\",BENEFIT_DESIGN!H18)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I18=0,\"None\",BENEFIT_DESIGN!I18)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B19","v":"Diagnostic Services: Laboratory"},{"$f":"BENEFIT_DESIGN!C19","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M19,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N19,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O19,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P19,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V19,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q19,BENEFIT_DESIGN!D19,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R19,BENEFIT_DESIGN!E19,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S19,BENEFIT_DESIGN!F19,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G19=0,\"None\",BENEFIT_DESIGN!G19)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H19=0,\"None\",BENEFIT_DESIGN!H19)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I19=0,\"None\",BENEFIT_DESIGN!I19)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B20","v":"Prescription Drugs: Generic"},{"$f":"BENEFIT_DESIGN!C20","v":"Rx Deductible+Co-ins"},{"$f":"IF(BENEFIT_DESIGN!M20,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N20,BENEFIT_DESIGN!$C$29,0)","v":100},{"$f":"IF(BENEFIT_DESIGN!O20,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P20,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V20,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q20,BENEFIT_DESIGN!D20,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R20,BENEFIT_DESIGN!E20,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S20,BENEFIT_DESIGN!F20,0)","v":0.1},{"$f":"IF(BENEFIT_DESIGN!G20=0,\"None\",BENEFIT_DESIGN!G20)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H20=0,\"None\",BENEFIT_DESIGN!H20)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I20=0,\"None\",BENEFIT_DESIGN!I20)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B21","v":"Prescription Drugs: Branded"},{"$f":"BENEFIT_DESIGN!C21","v":"Rx Deductible+Co-pay"},{"$f":"IF(BENEFIT_DESIGN!M21,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N21,BENEFIT_DESIGN!$C$29,0)","v":100},{"$f":"IF(BENEFIT_DESIGN!O21,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P21,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V21,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q21,BENEFIT_DESIGN!D21,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R21,BENEFIT_DESIGN!E21,0)","v":30},{"$f":"IF(BENEFIT_DESIGN!S21,BENEFIT_DESIGN!F21,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G21=0,\"None\",BENEFIT_DESIGN!G21)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H21=0,\"None\",BENEFIT_DESIGN!H21)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I21=0,\"None\",BENEFIT_DESIGN!I21)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B22","v":"Over-the-counter Drugs"},{"$f":"BENEFIT_DESIGN!C22","v":"Not Covered"},{"$f":"IF(BENEFIT_DESIGN!M22,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N22,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O22,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P22,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V22,BENEFIT_DESIGN!$C$32,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!Q22,BENEFIT_DESIGN!D22,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R22,BENEFIT_DESIGN!E22,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S22,BENEFIT_DESIGN!F22,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G22=0,\"None\",BENEFIT_DESIGN!G22)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H22=0,\"None\",BENEFIT_DESIGN!H22)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I22=0,\"None\",BENEFIT_DESIGN!I22)","v":"None"}]
[{"$f":"BENEFIT_DESIGN!B23","v":"Preventive Services & Vaccines"},{"$f":"BENEFIT_DESIGN!C23","v":"No Cost Sharing"},{"$f":"IF(BENEFIT_DESIGN!M23,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N23,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O23,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P23,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V23,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q23,BENEFIT_DESIGN!D23,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R23,BENEFIT_DESIGN!E23,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S23,BENEFIT_DESIGN!F23,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G23=0,\"None\",BENEFIT_DESIGN!G23)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H23=0,\"None\",BENEFIT_DESIGN!H23)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I23=0,\"None\",BENEFIT_DESIGN!I23)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B24","v":"Durable Medical Equipment"},{"$f":"BENEFIT_DESIGN!C24","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M24,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N24,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O24,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P24,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V24,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q24,BENEFIT_DESIGN!D24,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R24,BENEFIT_DESIGN!E24,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S24,BENEFIT_DESIGN!F24,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G24=0,\"None\",BENEFIT_DESIGN!G24)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H24=0,\"None\",BENEFIT_DESIGN!H24)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I24=0,\"None\",BENEFIT_DESIGN!I24)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B25","v":"Medical Supplies"},{"$f":"BENEFIT_DESIGN!C25","v":"Plan Deductible Only"},{"$f":"IF(BENEFIT_DESIGN!M25,BENEFIT_DESIGN!$C$28,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!N25,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O25,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P25,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V25,BENEFIT_DESIGN!$C$32,0)","v":1000},{"$f":"IF(BENEFIT_DESIGN!Q25,BENEFIT_DESIGN!D25,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R25,BENEFIT_DESIGN!E25,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S25,BENEFIT_DESIGN!F25,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G25=0,\"None\",BENEFIT_DESIGN!G25)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H25=0,\"None\",BENEFIT_DESIGN!H25)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I25=0,\"None\",BENEFIT_DESIGN!I25)","v":"Yes"}]
[{"$f":"BENEFIT_DESIGN!B26","v":"Over-the-counter Medical Supplies"},{"$f":"BENEFIT_DESIGN!C26","v":"Not Covered"},{"$f":"IF(BENEFIT_DESIGN!M26,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N26,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O26,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P26,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V26,BENEFIT_DESIGN!$C$32,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!Q26,BENEFIT_DESIGN!D26,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R26,BENEFIT_DESIGN!E26,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S26,BENEFIT_DESIGN!F26,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G26=0,\"None\",BENEFIT_DESIGN!G26)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H26=0,\"None\",BENEFIT_DESIGN!H26)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I26=0,\"None\",BENEFIT_DESIGN!I26)","v":"None"}]
[{"$f":"BENEFIT_DESIGN!B27","v":"Other Items & Services"},{"$f":"BENEFIT_DESIGN!C27","v":"Not Covered"},{"$f":"IF(BENEFIT_DESIGN!M27,BENEFIT_DESIGN!$C$28,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!N27,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!O27,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!P27,BENEFIT_DESIGN!$C$29,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!V27,BENEFIT_DESIGN!$C$32,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!Q27,BENEFIT_DESIGN!D27,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!R27,BENEFIT_DESIGN!E27,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!S27,BENEFIT_DESIGN!F27,0)","v":0},{"$f":"IF(BENEFIT_DESIGN!G27=0,\"None\",BENEFIT_DESIGN!G27)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!H27=0,\"None\",BENEFIT_DESIGN!H27)","v":"None"},{"$f":"IF(BENEFIT_DESIGN!I27=0,\"None\",BENEFIT_DESIGN!I27)","v":"None"}]

{"sheet":"RESULTS_SUMMARY","index":6,"n_rows":31,"n_cols":9,"rows_kept":31,"cut":false,"hidden":false,"merged":[]}
[]
[null,null,null,null,null,"Summary of Subscriber & Plan Payments"]
[]
[null,null,null,null,null,{"$f":"BENEFIT_DESIGN!$E$2","v":"3 of 3"}]
[]
[null,null,null,null,null,{"$f":"\"Summary for \"&BENEFIT_DESIGN!$B$6","v":"Summary for Plan 3"}]
[]
[null,"Maternity Example",null,null,null,null,"Diabetes Type 2 Example"]
[]
[null,null,"Plan Pays:",{"$f":"MATERNITY_SUMMARY!E26","v":11671.234999999999},null,null,null,"Plan Pays:",{"$f":"DIABETES_SUMMARY!$E$26","v":6334.0100000000011}]
[]
[]
[null,null,"Patient Pays:",{"$f":"MATERNITY_SUMMARY!F26","v":1060.0171345238095},null,null,null,"Patient Pays:",{"$f":"DIABETES_SUMMARY!F26","v":1055.26}]
[null,null,"Deductibles",{"$f":"MATERNITY_SUMMARY!G26","v":1000},null,null,null,"Deductibles",{"$f":"DIABETES_SUMMARY!$G$26","v":817.77300000000002}]
[null,null,"Copayments",{"$f":"MATERNITY_SUMMARY!H26","v":0},null,null,null,"Copayments",{"$f":"DIABETES_SUMMARY!$H$26","v":150}]
[null,null,"Coinsurance",{"$f":"MATERNITY_SUMMARY!I26","v":0},null,null,null,"Coinsurance",{"$f":"DIABETES_SUMMARY!$I$26","v":32.227000000000004}]
[null,null,"Exclusions & Limits",{"$f":"MATERNITY_SUMMARY!J26","v":60.017134523809524},null,null,null,"Exclusions & Limits",{"$f":"DIABETES_SUMMARY!$J$26","v":55.260000000000019}]
[]
[]
[]
[]
[null,"Foot Fracture Example"]
[]
[null,null,"Plan Pays:",{"$f":"FRACTURE_SUMMARY!$E$26","v":1211.96}]
[]
[]
[null,null,"Patient Pays:",{"$f":"FRACTURE_SUMMARY!F26","v":713.08}]
[null,null,"Deductibles",{"$f":"FRACTURE_SUMMARY!$G$26","v":713.08}]
[null,null,"Copayments",{"$f":"FRACTURE_SUMMARY!$H$26","v":0}]
[null,null,"Coinsurance",{"$f":"FRACTURE_SUMMARY!$I$26","v":0}]
[null,null,"Exclusions & Limits",{"$f":"FRACTURE_SUMMARY!$J$26","v":0}]

{"sheet":"EXAMPLE_SUMMARY","index":7,"n_rows":26,"n_cols":5,"rows_kept":26,"cut":false,"hidden":true,"merged":[]}
[]
[null,"Summary of allowed amount for each example"]
[]
[null,{"$f":"BENEFIT_DESIGN!$B$6","v":"Plan 3"},"Allowed Amount (unrounded)"]
[null,"Benefit category","Diabetes","Maternity","Foot Fracture"]
[null,{"$f":"BENEFIT_DESIGN!B8","v":"Inpatient Hospital Care (Facility)"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B6)","v":8959.380000000001},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B6)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B9","v":"Other Facility Services"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B7)","v":37.14}]
[null,{"$f":"BENEFIT_DESIGN!B10","v":"Emergency Department (Facility)"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B8)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B11","v":"Ambulance"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B9)","v":754.55000000000007}]
[null,{"$f":"BENEFIT_DESIGN!B12","v":"Professional Services: Primary Care"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B10)","v":791.28},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B10)","v":198},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B10)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B13","v":"Professional Services: Emergency Department"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B11)","v":557.41000000000008}]
[null,{"$f":"BENEFIT_DESIGN!B14","v":"Professional Services: Specialist"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B12)","v":273.24},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B12)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B12)","v":293.37}]
[null,{"$f":"BENEFIT_DESIGN!B15","v":"Professional Services: Obstetric Care (Bundled)"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B13)","v":2394.1799999999998},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B13)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B16","v":"Professional Services: Procedures & Other"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B14)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B17","v":"Professional Services: Physical Therapy"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B15)","v":215.76}]
[null,{"$f":"BENEFIT_DESIGN!B18","v":"Diagnostic Services: Radiology"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B16)","v":163.99},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B16)","v":30.2}]
[null,{"$f":"BENEFIT_DESIGN!B19","v":"Diagnostic Services: Laboratory"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B17)","v":133.69999999999999},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B17)","v":882.13999999999987},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B17)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B20","v":"Prescription Drugs: Generic"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B18)","v":676.12000000000012},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B18)","v":36.274999999999999},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B18)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B21","v":"Prescription Drugs: Branded"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B19)","v":3581.630000000001},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B19)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B22","v":"Over-the-counter Drugs"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B20)","v":55.260000000000019},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B20)","v":60.017134523809524},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B20)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B23","v":"Preventive Services & Vaccines"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B21)","v":150.11000000000001},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B21)","v":37.269999999999996},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B21)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B24","v":"Durable Medical Equipment"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B22)","v":36.61}]
[null,{"$f":"BENEFIT_DESIGN!B25","v":"Medical Supplies"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B23)","v":1727.9300000000005},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B23)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B26","v":"Over-the-counter Medical Supplies"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B24)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B27","v":"Other Items & Services"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B25)","v":0}]
[null,"Total (unrounded)",{"$f":"SUM(C6:C25)","v":7389.2700000000013},{"$f":"SUM(D6:D25)","v":12731.252134523809},{"$f":"SUM(E6:E25)","v":1925.0400000000002}]

{"sheet":"DIABETES_SUMMARY","index":8,"n_rows":27,"n_cols":10,"rows_kept":27,"cut":false,"hidden":true,"merged":[]}
[]
[null,"Type 2 Diabetes Example: Summary of Subscriber and Plan Payments"]
[]
[null,{"$f":"BENEFIT_DESIGN!$B$6","v":"Plan 3"},"Allowed Amount",null,null,"Subscriber pays:"]
[null,"Benefit category","Allowed Amount (unrounded)","Allowed Amount (rounded)","Plan payment (unrounded)","Total subscriber payment","Subscriber-paid deductible","Subscriber-paid copayment","Subscriber-paid coinsurance","Non-covered and exclusions"]
[null,{"$f":"BENEFIT_DESIGN!B8","v":"Inpatient Hospital Care (Facility)"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"MROUND(C6,IF(C6>=100,100,10))","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUM(G6:J6)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B6)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B6)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B9","v":"Other Facility Services"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"MROUND(C7,IF(C7>=100,100,10))","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUM(G7:J7)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B7)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B7)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B10","v":"Emergency Department (Facility)"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B8)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B8)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B8)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B8)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B11","v":"Ambulance"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B9)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B9)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B9)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B9)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B12","v":"Professional Services: Primary Care"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B10)","v":791.28},800,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B10)","v":701.28},90,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B10)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B10)","v":90},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B10)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B10)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B10)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B13","v":"Professional Services: Emergency Department"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B11)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B11)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B11)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B11)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B14","v":"Professional Services: Specialist"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B12)","v":273.24},300,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B12)","v":0},273.24,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B12)","v":273.24},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B12)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B12)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B12)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B12)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B15","v":"Professional Services: Obstetric Care (Bundled)"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B13)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B13)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B13)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B13)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B16","v":"Professional Services: Procedures & Other"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B14)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B14)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B14)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B14)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B17","v":"Professional Services: Physical Therapy"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B15)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B15)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B15)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B15)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B18","v":"Diagnostic Services: Radiology"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B16)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B16)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B16)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B16)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B19","v":"Diagnostic Services: Laboratory"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B17)","v":133.69999999999999},100,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B17)","v":57.170000000000009},76.53,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B17)","v":76.53},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B17)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B17)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B17)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B17)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B20","v":"Prescription Drugs: Generic"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B18)","v":676.12000000000012},700,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B18)","v":543.89300000000003},132.227,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B18)","v":100},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B18)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B18)","v":32.227000000000004},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B18)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B18)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B21","v":"Prescription Drugs: Branded"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B19)","v":3581.630000000001},3600,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B19)","v":3521.630000000001},60,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B19)","v":60},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B19)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B19)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B22","v":"Over-the-counter Drugs"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B20)","v":55.260000000000019},60,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B20)","v":0},55.260000000000019,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B20)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B20)","v":55.260000000000019}]
[null,{"$f":"BENEFIT_DESIGN!B23","v":"Preventive Services & Vaccines"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B21)","v":150.11000000000001},200,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B21)","v":150.11000000000001},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B21)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B21)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B24","v":"Durable Medical Equipment"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B22)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B22)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B22)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B22)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B25","v":"Medical Supplies"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B23)","v":1727.9300000000005},1700,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B23)","v":1359.9270000000004},368.00300000000004,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B23)","v":368.00300000000004},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B23)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B23)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B26","v":"Over-the-counter Medical Supplies"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B24)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B24)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B24)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B24)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B27","v":"Other Items & Services"},{"$f":"SUMIFS(DIABETES_TIMELINE!AllowedAmt,DIABETES_TIMELINE!BenefitCategory,$B25)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!PlanPaymentAmt,DIABETES_TIMELINE!BenefitCategory,$B25)","v":0},0,{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayDeduc,DIABETES_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCopay,DIABETES_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayCoins,DIABETES_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(DIABETES_TIMELINE!SubscriberPayNonCov,DIABETES_TIMELINE!BenefitCategory,$B25)+SUMIFS(DIABETES_TIMELINE!SubscriberPayExclusion,DIABETES_TIMELINE!BenefitCategory,$B25)","v":0}]
[null,"Total (unrounded)",{"$f":"SUM(C6:C25)","v":7389.2700000000013},null,{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(E6:E25)),\"ERROR\")","v":6334.0100000000011},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(F6:F25)),\"ERROR\")","v":1055.26},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(G6:G25)),\"ERROR\")","v":817.77300000000002},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(H6:H25)),\"ERROR\")","v":150},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(I6:I25)),\"ERROR\")","v":32.227000000000004},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(J6:J25)),\"ERROR\")","v":55.260000000000019}]
[null,"Total (rounded)",null,{"$f":"SUM(D6:D25)","v":7460},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",D27-F27),\"ERROR\")","v":6400},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(G27:J27)),\"ERROR\")","v":1060},{"$f":"IFERROR(IF(OR(BENEFIT_DESIGN_ERRORS!$D$34,BENEFIT_DESIGN_ERRORS!$E$34,BENEFIT_DESIGN_ERRORS!$H$34),\"ERROR\",MROUND(G26,10)),\"ERROR\")","v":820},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$I$34,\"ERROR\",MROUND(H26,10)),\"ERROR\")","v":150},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$J$34,\"ERROR\",MROUND(I26,10)),\"ERROR\")","v":30},{"$f":"IFERROR(IF(OR(BENEFIT_DESIGN_ERRORS!$K$34,BENEFIT_DESIGN_ERRORS!$L$34,BENEFIT_DESIGN_ERRORS!$M$34),\"ERROR\",MROUND(J26,10)),\"ERROR\")","v":60}]

{"sheet":"DIABETES_TIMELINE","index":9,"n_rows":128,"n_cols":50,"rows_kept":128,"cut":false,"hidden":false,"merged":[]}
[null,null,null,null,null,null,null,"Phase 1","Phase 2",null,"Phase 3",null,null,null,null,null,"Phase 4",null,null,"Phase 5","Phase 5: plan deductible",null,null,"Phase 5: Rx deductible",null,null,"Phase 5: optional deductible C",null,null,"Phase 5: optional deductible D",null,null,"Phase 5: benefit deductible",null,null,null,null,"Phase 6",null,null,null,"Phase 7",null,"Phase 8"]
["Claim number","Date","Calendar Month","Item or Service Code","Description","Benefit Category","Cost-sharing type","Allowed amount","Not covered","Covered amount","Monthly limit","Prior use (month)","subscriber pays because monthly limit exceeded","Annual limit","Prior use (annual)","subscriber pays because annual limit exceeded","Co-payment amount","Co-insurance rate","Co-insurance amount","Allowed amount after co-payment or co-insurance","Plan deductible applies","remaining plan deductible","subscriber pays toward plan deductible","Rx deductible applies","remaining Rx deductible","subscriber pays toward Rx deductible","deductible C applies","remaining deductible C","subscriber pays toward deductible C","deductible D applies","remaining deductible D","subscriber pays toward deductible D","benefit deductible applies","remaining benefit deductible","subscriber pays toward benefit deductible","subscriber pays toward any deductible","Covered amount remaining after deductibles","subscriber payment before OPL","OPL applies","amount subject to OPL","remaining OPL after subscriber payment","subscriber payment after OOP limit","plan payment","Not covered","Exclusions","Subscriber-paid copayment","Subscriber-paid coinsurance","Subscriber-paid deductible","Subscriber ChkSum","Allowable Charge ChkSum"]
[1,"2011-01-03",1,25,{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,6,FALSE)","v":"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]"},{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,5,FALSE)","v":"Over-the-counter Drugs"},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCostSharing),FALSE)","v":"Not Covered"},{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,7,FALSE)","v":2.6074999999999999},{"$f":"IF(CostSharingType=\"Not Covered\",AllowedAmt,0)","v":2.6074999999999999},{"$f":"IF((NotCoveredAmt+AmtExceedMonthLimit+AmtExceedAnnualLimit)>0,0,AllowedAmt)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimithMonth),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimMonth,ClaimMonth,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(MonthLimit=0,0,IF(PriorUseMonth>=MonthLimit,AllowedAmt,0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimitAnnual),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(AnnualLimit=0,0,IF(PriorUseAnnual>=AnnualLimit,AllowedAmt,0))","v":0},{"$f":"IF(AmtExceedMonthLimit=0,IF(AmtExceedAnnualLimit=0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCopay),FALSE),0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCoins),FALSE)","v":0},{"$f":"IF(AmtExceedMonthLimit=0,IF(AmtExceedAnnualLimit=0,CoInsRate*CoveredAmt,0))","v":0},{"$f":"IF((CoveredAmt-CoPayAmount-CoInsAmount)<0,0,CoveredAmt-CoPayAmount-CoInsAmount)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,PlanDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingPlanDeduc,AllowedAmtAfterCopayCoins,RemainingPlanDeduc)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,RxDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingRxDeduc,AllowedAmtAfterCopayCoins,RemainingRxDeduc)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleCApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleC,AllowedAmtAfterCopayCoins,RemainingDeductibleC)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleDApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleD,AllowedAmtAfterCopayCoins,RemainingDeductibleD)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,BenefitCategory,BenefitCategory,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingBenefitDeduc,AllowedAmtAfterCopayCoins,RemainingBenefitDeduc)","v":0},{"$f":"PlanDeductiblePayment+RxDeductiblePayment+DeductibleCPayment+DeductibleDPayment+BenefitDeductiblePayment","v":0},{"$f":"MAX(0,CoveredAmt-PaymentTowardDeductibles)","v":0},{"$f":"PaymentTowardDeductibles+CoPayAmount+CoInsAmount","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitOOPLimitApplies),FALSE)=\"Yes\"","v":false},{"$f":"IF(OPLApplies,SubscriberPaymentBeforeOPL,0)","v":0},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OPLimit),FALSE)-SUMIFS(AmountSubjectToOPL,OPLApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},{"$f":"IF((CoveredAmt-SubscriberPaymentAfterOPL)<0,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":0},{"$f":"NotCoveredAmt","v":2.6074999999999999},{"$f":"AmtExceedMonthLimit+AmtExceedAnnualLimit","v":0},{"$f":"IF(CoPayAmount<SubscriberPaymentAfterOPL,CoPayAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"IF(CoInsAmount<SubscriberPaymentAfterOPL,CoInsAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},{"$f":"SUM(AS3:AV3)=AP3","v":true},{"$f":"SUM(AQ3:AV3)=H3","v":true}]
[2,"2011-01-03",1,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",0,0,0,0,0,42.66,true,1000,42.66,false,0,0,false,0,0,false,0,0,false,0,0,42.66,0,42.66,true,42.66,1000,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":42.66},{"$f":"IF(CoveredAmt<SubscriberPaymentAfterOPL,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":0},0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":42.66},true,true]
[3,"2011-01-03",1,5,"OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","Medical Supplies","Plan Deductible Only",10.38,0,10.38,"None",0,0,"None",0,0,0,0,0,10.38,true,957.34,10.38,false,0,0,false,0,0,false,0,0,false,0,0,10.38,0,10.38,true,10.38,957.34,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":10.38},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":10.38},true,true]
[4,"2011-01-03",1,3,"OneTouch Delica Lancing Device ","Medical Supplies","Plan Deductible Only",16.12,0,16.12,"None",0,0,"None",0,0,0,0,0,16.12,true,946.96,16.12,false,0,0,false,0,0,false,0,0,false,0,0,16.12,0,16.12,true,16.12,946.96,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":16.12},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":16.12},true,true]
[5,"2011-01-03",1,7,"OneTouch Ultra 2 Blood Glucose Meter Kit","Medical Supplies","Plan Deductible Only",56.9,0,56.9,"None",0,0,"None",0,0,0,0,0,56.9,true,930.84,56.9,false,0,0,false,0,0,false,0,0,false,0,0,56.9,0,56.9,true,56.9,930.84,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":56.9},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":56.9},true,true]
[6,"2011-01-03",1,4,"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","Medical Supplies","Plan Deductible Only",125.26,0,125.26,"None",0,0,"None",0,0,0,0,0,125.26,true,873.94,125.26,false,0,0,false,0,0,false,0,0,false,0,0,125.26,0,125.26,true,125.26,873.94,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":125.26},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":125.26},true,true]
[7,"2011-01-03",1,6,"OneTouch Ultra Control Solution (2 vials/box)","Medical Supplies","Plan Deductible Only",5.07,0,5.07,"None",0,0,"None",0,0,0,0,0,5.07,true,748.68000000000006,5.07,false,0,0,false,0,0,false,0,0,false,0,0,5.07,0,5.07,true,5.07,748.68000000000006,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":5.07},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":5.07},true,true]
[8,"2011-01-03",1,26,"Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","Over-the-counter Drugs","Not Covered",4.2725,4.2725,0,"None",0,0,"None",0,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,4.2725,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[9,"2011-01-03",1,1,"Glucagon Emergency Kit","Prescription Drugs: Generic","Rx Deductible+Co-ins",246.17,0,246.17,"None",0,0,"None",0,0,0,0.1,24.617000000000001,221.553,false,0,0,true,100,100,false,0,0,false,0,0,false,0,0,100,146.16999999999999,124.617,true,124.617,743.61,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":124.617},121.55299999999998,0,0,0,24.617000000000001,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":100},true,true]
[10,"2011-01-03",1,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",0,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,618.99299999999994,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":30},245.51,0,0,30,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[11,"2011-01-03",1,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",0,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,588.99299999999994,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0.91900000000000004},8.270999999999999,0,0,0,0.91900000000000004,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[12,"2011-01-03",1,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",0,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,588.07400000000007,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":1.5920000000000001},14.327999999999999,0,0,0,1.5920000000000001,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[13,"2011-01-03",1,33,"Atorvastatin 20 MG tablet 90 CT","Prescription Drugs: Generic","Rx Deductible+Co-ins",25.88,0,25.88,"None",0,0,"None",0,0,0,0.1,2.5880000000000001,23.291999999999998,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,25.88,2.5880000000000001,true,2.5880000000000001,586.48199999999997,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":2.5880000000000001},23.291999999999998,0,0,0,2.5880000000000001,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[14,"2011-01-03",1,15,"Assay Glucose Blood Quant","Diagnostic Services: Laboratory","Plan Deductible Only",5.73,0,5.73,"None",0,0,"None",0,0,0,0,0,5.73,true,743.61,5.73,false,0,0,false,0,0,false,0,0,false,0,0,5.73,0,5.73,true,5.73,583.89400000000001,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":5.73},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":5.73},true,true]
[15,"2011-01-03",1,13,"Assay of Urine Creatinine","Diagnostic Services: Laboratory","Plan Deductible Only",5.79,0,5.79,"None",0,0,"None",0,0,0,0,0,5.79,true,737.88,5.79,false,0,0,false,0,0,false,0,0,false,0,0,5.79,0,5.79,true,5.79,578.16399999999999,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":5.79},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":5.79},true,true]
[16,"2011-01-03",1,8,"Comprehen Metabolic Panel","Diagnostic Services: Laboratory","Plan Deductible Only",14.53,0,14.53,"None",0,0,"None",0,0,0,0,0,14.53,true,732.08999999999992,14.53,false,0,0,false,0,0,false,0,0,false,0,0,14.53,0,14.53,true,14.53,572.37400000000002,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":14.53},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":14.53},true,true]
[17,"2011-01-03",1,16,"Glycosylated Hemoglobin Test","Diagnostic Services: Laboratory","Plan Deductible Only",10.85,0,10.85,"None",0,0,"None",0,0,0,0,0,10.85,true,717.56,10.85,false,0,0,false,0,0,false,0,0,false,0,0,10.85,0,10.85,true,10.85,557.84400000000005,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":10.85},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":10.85},true,true]
[18,"2011-01-03",1,9,"Lipid panel","Diagnostic Services: Laboratory","Plan Deductible Only",14.42,0,14.42,"None",0,0,"None",0,0,0,0,0,14.42,true,706.71,14.42,false,0,0,false,0,0,false,0,0,false,0,0,14.42,0,14.42,true,14.42,546.99399999999991,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":14.42},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":14.42},true,true]
[19,"2011-01-03",1,12,"Microalbumin Quantitative","Diagnostic Services: Laboratory","Plan Deductible Only",6.32,0,6.32,"None",0,0,"None",0,0,0,0,0,6.32,true,692.29,6.32,false,0,0,false,0,0,false,0,0,false,0,0,6.32,0,6.32,true,6.32,532.57399999999996,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":6.32},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":6.32},true,true]
[20,"2011-01-03",1,10,"Renal Function Panel","Diagnostic Services: Laboratory","Plan Deductible Only",11.63,0,11.63,"None",0,0,"None",0,0,0,0,0,11.63,true,685.97,11.63,false,0,0,false,0,0,false,0,0,false,0,0,11.63,0,11.63,true,11.63,526.25399999999991,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":11.63},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":11.63},true,true]
[21,"2011-01-03",1,2,"Routine Venipuncture","Diagnostic Services: Laboratory","Plan Deductible Only",4.17,0,4.17,"None",0,0,"None",0,0,0,0,0,4.17,true,674.33999999999992,4.17,false,0,0,false,0,0,false,0,0,false,0,0,4.17,0,4.17,true,4.17,514.62400000000002,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":4.17},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":4.17},true,true]
[22,"2011-01-03",1,11,"Urinalysis Auto W/O Scope","Diagnostic Services: Laboratory","Plan Deductible Only",3.09,0,3.09,"None",0,0,"None",0,0,0,0,0,3.09,true,670.17,3.09,false,0,0,false,0,0,false,0,0,false,0,0,3.09,0,3.09,true,3.09,510.45399999999995,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":3.09},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":3.09},true,true]
[23,"2011-01-03",1,24,"Office/Outpatient Visit Est","Professional Services: Primary Care","Copayment Only",107.87,0,107.87,"None",0,0,"None",0,0,30,0,0,77.87,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,107.87,30,true,30,507.36399999999998,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":30},77.87,0,0,30,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[24,"2011-01-04",1,21,"Self-mgmt educ & train 1 pt","Professional Services: Primary Care","Copayment Only",99.9,0,99.9,"None",0,0,"None",0,0,30,0,0,69.900000000000006,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,99.9,30,true,30,477.36400000000003,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":30},69.900000000000006,0,0,30,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[25,"2011-01-04",1,20,"Med Nutrition Indiv Subseq","Professional Services: Primary Care","Copayment Only",80,0,80,"None",0,0,"None",0,0,30,0,0,50,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,80,30,true,30,447.36400000000003,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":30},50,0,0,30,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[26,"2011-01-06",1,23,"Office/Outpatient Visit New","Professional Services: Specialist","Plan Deductible Only",165,0,165,"None",0,0,"None",0,0,0,0,0,165,true,667.07999999999993,165,false,0,0,false,0,0,false,0,0,false,0,0,165,0,165,true,165,417.36400000000003,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":165},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":165},true,true]
[27,"2011-01-07",1,22,"Ophthalmological services: medical examination & evaluation, with initiation or continuation of diagnostic and treatment program, comprehensive, established patient, 1 or more visits","Professional Services: Specialist","Plan Deductible Only",108.24,0,108.24,"None",0,0,"None",0,0,0,0,0,108.24,true,502.08,108.24,false,0,0,false,0,0,false,0,0,false,0,0,108.24,0,108.24,true,108.24,252.36400000000003,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":108.24},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":108.24},true,true]
[28,"2011-01-31",1,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",1,0,"None",1,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,144.12400000000002,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":30},245.51,0,0,30,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[29,"2011-02-02",2,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",1,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[30,"2011-02-02",2,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",1,0,0,0,0,42.66,true,393.84000000000003,42.66,false,0,0,false,0,0,false,0,0,false,0,0,42.66,0,42.66,true,42.66,114.12400000000002,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":42.66},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":42.66},true,true]
[31,"2011-02-02",2,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",1,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,71.464000000000055,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0.91900000000000004},8.270999999999999,0,0,0,0.91900000000000004,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[32,"2011-02-02",2,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",1,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,70.545000000000073,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":1.5920000000000001},14.327999999999999,0,0,0,1.5920000000000001,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[33,"2011-02-22",2,5,{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,6,FALSE)","v":"OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]"},{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,5,FALSE)","v":"Medical Supplies"},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCostSharing),FALSE)","v":"Plan Deductible Only"},{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,7,FALSE)","v":10.38},{"$f":"IF(CostSharingType=\"Not Covered\",AllowedAmt,0)","v":0},{"$f":"IF((NotCoveredAmt+AmtExceedMonthLimit+AmtExceedAnnualLimit)>0,0,AllowedAmt)","v":10.38},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimithMonth),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimMonth,ClaimMonth,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(MonthLimit=0,0,IF(PriorUseMonth>=MonthLimit,AllowedAmt,0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimitAnnual),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimNumber,\"<\"&ClaimNumber)","v":1},{"$f":"IF(AnnualLimit=0,0,IF(PriorUseAnnual>=AnnualLimit,AllowedAmt,0))","v":0},0,0,0,{"$f":"IF((CoveredAmt-CoPayAmount-CoInsAmount)<0,0,CoveredAmt-CoPayAmount-CoInsAmount)","v":10.38},true,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,PlanDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":351.18000000000006},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingPlanDeduc,AllowedAmtAfterCopayCoins,RemainingPlanDeduc)","v":10.38},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,RxDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingRxDeduc,AllowedAmtAfterCopayCoins,RemainingRxDeduc)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleCApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleC,AllowedAmtAfterCopayCoins,RemainingDeductibleC)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleDApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleD,AllowedAmtAfterCopayCoins,RemainingDeductibleD)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,BenefitCategory,BenefitCategory,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingBenefitDeduc,AllowedAmtAfterCopayCoins,RemainingBenefitDeduc)","v":0},{"$f":"PlanDeductiblePayment+RxDeductiblePayment+DeductibleCPayment+DeductibleDPayment+BenefitDeductiblePayment","v":10.38},0,10.38,true,10.38,68.953000000000088,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":10.38},0,{"$f":"NotCoveredAmt","v":0},{"$f":"AmtExceedMonthLimit+AmtExceedAnnualLimit","v":0},{"$f":"IF(CoPayAmount<SubscriberPaymentAfterOPL,CoPayAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"IF(CoInsAmount<SubscriberPaymentAfterOPL,CoInsAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":10.38},{"$f":"SUM(AS35:AV35)=AP35","v":true},{"$f":"SUM(AQ35:AV35)=H35","v":true}]
[34,"2011-02-22",2,4,"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","Medical Supplies","Plan Deductible Only",125.26,0,125.26,"None",0,0,"None",1,0,0,0,0,125.26,true,340.80000000000007,125.26,false,0,0,false,0,0,false,0,0,false,0,0,125.26,0,125.26,true,125.26,58.573000000000093,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":58.573000000000093},{"$f":"IF(CoveredAmt<SubscriberPaymentAfterOPL,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":66.686999999999912},0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":58.573000000000093},true,true]
[35,"2011-02-28",2,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",2,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[36,"2011-03-04",3,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",2,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[37,"2011-03-04",3,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",2,0,0,0,0,42.66,true,215.54000000000008,42.66,false,0,0,false,0,0,false,0,0,false,0,0,42.66,0,42.66,true,42.66,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[38,"2011-03-04",3,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",2,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[39,"2011-03-04",3,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",2,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[40,"2011-03-28",3,26,"Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","Over-the-counter Drugs","Not Covered",4.2725,4.2725,0,"None",0,0,"None",1,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,4.2725,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[41,"2011-03-28",3,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",3,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[42,"2011-03-28",3,24,"Office/Outpatient Visit Est","Professional Services: Primary Care","Copayment Only",107.87,0,107.87,"None",0,0,"None",1,0,30,0,0,77.87,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,107.87,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},107.87,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[43,"2011-04-03",4,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",3,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[44,"2011-04-03",4,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",3,0,0,0,0,42.66,true,172.88000000000011,42.66,false,0,0,false,0,0,false,0,0,false,0,0,42.66,0,42.66,true,42.66,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[45,"2011-04-03",4,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",3,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[46,"2011-04-03",4,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",3,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[47,"2011-04-03",4,33,"Atorvastatin 20 MG tablet 90 CT","Prescription Drugs: Generic","Rx Deductible+Co-ins",25.88,0,25.88,"None",0,0,"None",1,0,0,0.1,2.5880000000000001,23.291999999999998,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,25.88,2.5880000000000001,true,2.5880000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},25.88,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[48,"2011-04-03",4,16,"Glycosylated Hemoglobin Test","Diagnostic Services: Laboratory","Plan Deductible Only",10.85,0,10.85,"None",0,0,"None",1,0,0,0,0,10.85,true,130.22000000000014,10.85,false,0,0,false,0,0,false,0,0,false,0,0,10.85,0,10.85,true,10.85,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.85,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[49,"2011-04-13",4,5,"OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","Medical Supplies","Plan Deductible Only",10.38,0,10.38,"None",0,0,"None",2,0,0,0,0,10.38,true,119.37000000000012,10.38,false,0,0,false,0,0,false,0,0,false,0,0,10.38,0,10.38,true,10.38,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.38,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[50,"2011-04-13",4,4,"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","Medical Supplies","Plan Deductible Only",125.26,0,125.26,"None",0,0,"None",2,0,0,0,0,125.26,true,108.99000000000012,108.99000000000012,false,0,0,false,0,0,false,0,0,false,0,0,108.99000000000012,16.269999999999882,108.99000000000012,true,108.99000000000012,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},125.26,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[51,"2011-04-25",4,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",4,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[52,"2011-05-03",5,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",4,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[53,"2011-05-03",5,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",4,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[54,"2011-05-03",5,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",4,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[55,"2011-05-03",5,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",4,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[56,"2012-05-23",5,5,"OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","Medical Supplies","Plan Deductible Only",10.38,0,10.38,"None",0,0,"None",3,0,0,0,0,10.38,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,10.38,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.38,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[57,"2011-05-23",5,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",5,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[58,"2011-06-02",6,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",5,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[59,"2011-06-02",6,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",5,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[60,"2011-06-02",6,5,"OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","Medical Supplies","Plan Deductible Only",10.38,0,10.38,"None",0,0,"None",4,0,0,0,0,10.38,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,10.38,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.38,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[61,"2011-06-02",6,4,"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","Medical Supplies","Plan Deductible Only",125.26,0,125.26,"None",0,0,"None",3,0,0,0,0,125.26,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,125.26,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},125.26,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[62,"2011-06-02",6,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",5,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[63,"2011-06-02",6,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",5,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[64,"2011-06-20",6,26,"Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","Over-the-counter Drugs","Not Covered",4.2725,4.2725,0,"None",0,0,"None",2,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,4.2725,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[65,"2011-06-20",6,17,{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,6,FALSE)","v":"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]"},{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,5,FALSE)","v":"Prescription Drugs: Branded"},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCostSharing),FALSE)","v":"Rx Deductible+Co-pay"},{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,7,FALSE)","v":275.51},{"$f":"IF(CostSharingType=\"Not Covered\",AllowedAmt,0)","v":0},{"$f":"IF((NotCoveredAmt+AmtExceedMonthLimit+AmtExceedAnnualLimit)>0,0,AllowedAmt)","v":275.51},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimithMonth),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimMonth,ClaimMonth,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(MonthLimit=0,0,IF(PriorUseMonth>=MonthLimit,AllowedAmt,0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimitAnnual),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimNumber,\"<\"&ClaimNumber)","v":6},{"$f":"IF(AnnualLimit=0,0,IF(PriorUseAnnual>=AnnualLimit,AllowedAmt,0))","v":0},{"$f":"IF(AmtExceedMonthLimit=0,IF(AmtExceedAnnualLimit=0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCopay),FALSE),0))","v":30},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCoins),FALSE)","v":0},{"$f":"IF(AmtExceedMonthLimit=0,IF(AmtExceedAnnualLimit=0,CoInsRate*CoveredAmt,0))","v":0},{"$f":"IF((CoveredAmt-CoPayAmount-CoInsAmount)<0,0,CoveredAmt-CoPayAmount-CoInsAmount)","v":245.51},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,PlanDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingPlanDeduc,AllowedAmtAfterCopayCoins,RemainingPlanDeduc)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)>0","v":true},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,RxDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingRxDeduc,AllowedAmtAfterCopayCoins,RemainingRxDeduc)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleCApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleC,AllowedAmtAfterCopayCoins,RemainingDeductibleC)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleDApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleD,AllowedAmtAfterCopayCoins,RemainingDeductibleD)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,BenefitCategory,BenefitCategory,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingBenefitDeduc,AllowedAmtAfterCopayCoins,RemainingBenefitDeduc)","v":0},{"$f":"PlanDeductiblePayment+RxDeductiblePayment+DeductibleCPayment+DeductibleDPayment+BenefitDeductiblePayment","v":0},{"$f":"MAX(0,CoveredAmt-PaymentTowardDeductibles)","v":275.51},{"$f":"PaymentTowardDeductibles+CoPayAmount+CoInsAmount","v":30},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitOOPLimitApplies),FALSE)=\"Yes\"","v":true},{"$f":"IF(OPLApplies,SubscriberPaymentBeforeOPL,0)","v":30},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OPLimit),FALSE)-SUMIFS(AmountSubjectToOPL,OPLApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,{"$f":"NotCoveredAmt","v":0},{"$f":"AmtExceedMonthLimit+AmtExceedAnnualLimit","v":0},{"$f":"IF(CoPayAmount<SubscriberPaymentAfterOPL,CoPayAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"IF(CoInsAmount<SubscriberPaymentAfterOPL,CoInsAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},{"$f":"SUM(AS67:AV67)=AP67","v":true},{"$f":"SUM(AQ67:AV67)=H67","v":true}]
[66,"2011-06-27",6,15,"Assay Glucose Blood Quant","Diagnostic Services: Laboratory","Plan Deductible Only",5.73,0,5.73,"None",0,0,"None",1,0,0,0,0,5.73,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,5.73,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},{"$f":"IF(CoveredAmt<SubscriberPaymentAfterOPL,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":5.73},0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[67,"2011-06-27",6,16,"Glycosylated Hemoglobin Test","Diagnostic Services: Laboratory","Plan Deductible Only",10.85,0,10.85,"None",0,0,"None",2,0,0,0,0,10.85,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,10.85,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.85,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[68,"2011-06-27",6,10,"Renal Function Panel","Diagnostic Services: Laboratory","Plan Deductible Only",11.63,0,11.63,"None",0,0,"None",1,0,0,0,0,11.63,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,11.63,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},11.63,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[69,"2011-06-27",6,2,"Routine Venipuncture","Diagnostic Services: Laboratory","Plan Deductible Only",4.17,0,4.17,"None",0,0,"None",1,0,0,0,0,4.17,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,4.17,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},4.17,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[70,"2011-06-27",6,11,"Urinalysis Auto W/O Scope","Diagnostic Services: Laboratory","Plan Deductible Only",3.09,0,3.09,"None",0,0,"None",1,0,0,0,0,3.09,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,3.09,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},3.09,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[71,"2011-06-27",6,24,"Office/Outpatient Visit Est","Professional Services: Primary Care","Copayment Only",107.87,0,107.87,"None",0,0,"None",2,0,30,0,0,77.87,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,107.87,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},107.87,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[72,"2011-06-28",6,21,"Self-mgmt educ & train 1 pt","Professional Services: Primary Care","Copayment Only",99.9,0,99.9,"None",0,0,"None",1,0,30,0,0,69.900000000000006,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,99.9,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},99.9,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[73,"2011-06-28",6,20,"Med Nutrition Indiv Subseq","Professional Services: Primary Care","Copayment Only",80,0,80,"None",0,0,"None",1,0,30,0,0,50,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,80,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},80,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[74,"2011-07-02",7,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",6,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[75,"2011-07-02",7,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",6,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[76,"2011-07-02",7,6,"OneTouch Ultra Control Solution (2 vials/box)","Medical Supplies","Plan Deductible Only",5.07,0,5.07,"None",0,0,"None",1,0,0,0,0,5.07,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,5.07,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},5.07,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[77,"2011-07-02",7,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",6,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[78,"2011-07-02",7,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",6,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[79,"2011-07-02",7,33,"Atorvastatin 20 MG tablet 90 CT","Prescription Drugs: Generic","Rx Deductible+Co-ins",25.88,0,25.88,"None",0,0,"None",2,0,0,0.1,2.5880000000000001,23.291999999999998,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,25.88,2.5880000000000001,true,2.5880000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},25.88,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[80,"2011-07-18",7,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",7,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[81,"2011-07-22",7,4,"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","Medical Supplies","Plan Deductible Only",125.26,0,125.26,"None",0,0,"None",4,0,0,0,0,125.26,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,125.26,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},125.26,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[82,"2011-08-01",8,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",7,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[83,"2011-08-01",8,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",7,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[84,"2011-08-01",8,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",7,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[85,"2011-08-01",8,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",7,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[86,"2011-08-15",8,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",8,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[87,"2011-08-16",8,4,"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","Medical Supplies","Plan Deductible Only",125.26,0,125.26,"None",0,0,"None",5,0,0,0,0,125.26,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,125.26,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},125.26,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[88,"2011-08-31",8,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",1,0,"None",8,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[89,"2011-08-31",8,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",1,0,"None",8,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[90,"2011-08-31",8,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",1,0,"None",8,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[91,"2011-08-31",8,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",1,0,"None",8,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[92,"2011-09-10",9,5,"OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","Medical Supplies","Plan Deductible Only",10.38,0,10.38,"None",0,0,"None",5,0,0,0,0,10.38,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,10.38,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.38,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[93,"2011-09-10",9,4,"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","Medical Supplies","Plan Deductible Only",125.26,0,125.26,"None",0,0,"None",6,0,0,0,0,125.26,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,125.26,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},125.26,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[94,"2011-09-12",9,26,"Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","Over-the-counter Drugs","Not Covered",4.2725,4.2725,0,"None",0,0,"None",3,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,4.2725,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[95,"2011-09-12",9,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",9,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[96,"2011-09-26",9,24,"Office/Outpatient Visit Est","Professional Services: Primary Care","Copayment Only",107.87,0,107.87,"None",0,0,"None",3,0,30,0,0,77.87,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,107.87,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},107.87,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[97,"2011-09-30",9,25,{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,6,FALSE)","v":"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]"},{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,5,FALSE)","v":"Over-the-counter Drugs"},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCostSharing),FALSE)","v":"Not Covered"},{"$f":"VLOOKUP(ServiceCode,DiabetesFeeSchedule,7,FALSE)","v":2.6074999999999999},{"$f":"IF(CostSharingType=\"Not Covered\",AllowedAmt,0)","v":2.6074999999999999},{"$f":"IF((NotCoveredAmt+AmtExceedMonthLimit+AmtExceedAnnualLimit)>0,0,AllowedAmt)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimithMonth),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimMonth,ClaimMonth,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(MonthLimit=0,0,IF(PriorUseMonth>=MonthLimit,AllowedAmt,0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimitAnnual),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimNumber,\"<\"&ClaimNumber)","v":9},{"$f":"IF(AnnualLimit=0,0,IF(PriorUseAnnual>=AnnualLimit,AllowedAmt,0))","v":0},0,0,0,{"$f":"IF((CoveredAmt-CoPayAmount-CoInsAmount)<0,0,CoveredAmt-CoPayAmount-CoInsAmount)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,PlanDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingPlanDeduc,AllowedAmtAfterCopayCoins,RemainingPlanDeduc)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,RxDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingRxDeduc,AllowedAmtAfterCopayCoins,RemainingRxDeduc)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleCApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleC,AllowedAmtAfterCopayCoins,RemainingDeductibleC)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleDApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleD,AllowedAmtAfterCopayCoins,RemainingDeductibleD)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,BenefitCategory,BenefitCategory,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingBenefitDeduc,AllowedAmtAfterCopayCoins,RemainingBenefitDeduc)","v":0},{"$f":"PlanDeductiblePayment+RxDeductiblePayment+DeductibleCPayment+DeductibleDPayment+BenefitDeductiblePayment","v":0},0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,{"$f":"NotCoveredAmt","v":2.6074999999999999},{"$f":"AmtExceedMonthLimit+AmtExceedAnnualLimit","v":0},{"$f":"IF(CoPayAmount<SubscriberPaymentAfterOPL,CoPayAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"IF(CoInsAmount<SubscriberPaymentAfterOPL,CoInsAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},{"$f":"SUM(AS99:AV99)=AP99","v":true},{"$f":"SUM(AQ99:AV99)=H99","v":true}]
[98,"2011-09-30",9,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",9,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},{"$f":"IF(CoveredAmt<SubscriberPaymentAfterOPL,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":42.66},0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[99,"2011-09-30",9,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",9,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[100,"2011-09-30",9,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",9,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[101,"2011-10-03",10,28,"Immunization admin each add ","Preventive Services & Vaccines","No Cost Sharing",14.98,0,14.98,"None",0,0,"None",0,0,0,0,0,14.98,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,14.98,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},14.98,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[102,"2011-10-03",10,27,"Immunization Admin ADMIN","Preventive Services & Vaccines","No Cost Sharing",23,0,23,"None",0,0,"None",0,0,0,0,0,23,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,23,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},23,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[103,"2011-10-03",10,29,"Pneumococcal vacc 7 val im","Preventive Services & Vaccines","No Cost Sharing",97.86,0,97.86,"None",0,0,"None",0,0,0,0,0,97.86,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,97.86,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},97.86,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[104,"2011-10-03",10,30,"Flu Vaccine No Preserv 3 & >","Preventive Services & Vaccines","No Cost Sharing",14.27,0,14.27,"None",0,0,"None",0,0,0,0,0,14.27,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,14.27,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},14.27,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[105,"2011-10-03",10,33,"Atorvastatin 20 MG tablet 90 CT","Prescription Drugs: Generic","Rx Deductible+Co-ins",25.88,0,25.88,"None",0,0,"None",3,0,0,0.1,2.5880000000000001,23.291999999999998,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,25.88,2.5880000000000001,true,2.5880000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},25.88,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[106,"2011-10-03",10,16,"Glycosylated Hemoglobin Test","Diagnostic Services: Laboratory","Plan Deductible Only",10.85,0,10.85,"None",0,0,"None",3,0,0,0,0,10.85,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,10.85,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.85,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[107,"2011-10-10",10,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",10,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[108,"2011-10-30",10,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",10,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[109,"2011-10-30",10,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",10,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[110,"2011-10-30",10,5,"OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","Medical Supplies","Plan Deductible Only",10.38,0,10.38,"None",0,0,"None",6,0,0,0,0,10.38,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,10.38,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.38,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[111,"2011-10-30",10,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",10,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[112,"2011-10-30",10,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",10,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[113,"2011-11-07",11,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",11,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[114,"2011-11-29",11,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",11,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[115,"2011-11-29",11,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",11,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[116,"2011-11-29",11,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",11,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[117,"2011-11-29",11,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",11,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[118,"2011-12-05",12,26,"Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]","Over-the-counter Drugs","Not Covered",4.2725,4.2725,0,"None",0,0,"None",4,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,4.2725,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[119,"2011-12-05",12,17,"Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]","Prescription Drugs: Branded","Rx Deductible+Co-pay",275.51,0,275.51,"None",0,0,"None",12,0,30,0,0,245.51,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,275.51,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},275.51,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[120,"2011-12-19",12,5,"OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]","Medical Supplies","Plan Deductible Only",10.38,0,10.38,"None",0,0,"None",7,0,0,0,0,10.38,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,10.38,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},10.38,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[121,"2011-12-19",12,4,"OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ","Medical Supplies","Plan Deductible Only",125.26,0,125.26,"None",0,0,"None",7,0,0,0,0,125.26,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,125.26,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},125.26,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[122,"2011-12-29",12,25,"Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]","Over-the-counter Drugs","Not Covered",2.6074999999999999,2.6074999999999999,0,"None",0,0,"None",12,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,2.6074999999999999,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[123,"2011-12-29",12,14,"BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]","Medical Supplies","Plan Deductible Only",42.66,0,42.66,"None",0,0,"None",12,0,0,0,0,42.66,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,42.66,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},42.66,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[124,"2011-12-29",12,6,"OneTouch Ultra Control Solution (2 vials/box)","Medical Supplies","Plan Deductible Only",5.07,0,5.07,"None",0,0,"None",2,0,0,0,0,5.07,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,5.07,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},5.07,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[125,"2011-12-29",12,32,"METFORMIN HCL 850 MG TABLET","Prescription Drugs: Generic","Rx Deductible+Co-ins",9.19,0,9.19,"None",0,0,"None",12,0,0,0.1,0.91900000000000004,8.270999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,9.19,0.91900000000000004,true,0.91900000000000004,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},9.19,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[126,"2011-12-29",12,19,"Ramipril 10mg (Rx) [1 QD; #30 pills/month]","Prescription Drugs: Generic","Rx Deductible+Co-ins",15.92,0,15.92,"None",0,0,"None",12,0,0,0.1,1.5920000000000001,14.327999999999999,false,0,0,true,0,0,false,0,0,false,0,0,false,0,0,0,15.92,1.5920000000000001,true,1.5920000000000001,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},15.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]

{"sheet":"DIABETES_LINE_ITEM","index":10,"n_rows":34,"n_cols":10,"rows_kept":34,"cut":false,"hidden":true,"merged":[]}
["Item or Service Code","Diagnosis Code \n(ICD-10)","CPT©, HCPCS, or\nOther Billing Code","Provider\nType","Benefit Category","Description","Allowed\nAmount","Notes","Valid Benefit Category","Timeline Count"]
[1,"E119.00, Z7982, Z794",2803101,"Pharmacy Retail","Prescription Drugs: Generic","Glucagon Emergency Kit",246.17,null,{"$f":"IF(ISERROR(VLOOKUP(E2,BenefitCategoryList,1,FALSE)),FALSE,TRUE)","v":true},{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A2)","v":1}]
[2,"E119.00, Z7982, Z794",36415,"Primary","Diagnostic Services: Laboratory","Routine Venipuncture",4.17,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A3)","v":2}]
[3,"E119.00, Z7982, Z794",53885014201,"Pharmacy Retail","Medical Supplies","OneTouch Delica Lancing Device ",16.12,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A4)","v":1}]
[4,"E119.00, Z7982, Z794",53885024510,"Pharmacy Retail","Medical Supplies","OneTouch Ultra Blue Test Strips (Rx - box of 100) [usage = 2 strips/day; 60 per month] ",125.26,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A5)","v":8}]
[5,"E119.00, Z7982, Z794",53885039310,"Pharmacy Retail","Medical Supplies","OneTouch Delica Lancets (100 per box)  [usage = 60 lancets per month]",10.38,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A6)","v":8}]
[6,"E119.00, Z7982, Z794",53885041601,"Pharmacy Retail","Medical Supplies","OneTouch Ultra Control Solution (2 vials/box)",5.07,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A7)","v":3}]
[7,"E119.00, Z7982, Z794",53885044801,"Pharmacy Retail","Medical Supplies","OneTouch Ultra 2 Blood Glucose Meter Kit",56.9,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A8)","v":1}]
[8,"E119.00, Z7982, Z794",80053,"Primary","Diagnostic Services: Laboratory","Comprehen Metabolic Panel",14.53,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A9)","v":1}]
[9,"E119.00, Z7982, Z794",80061,"Primary","Diagnostic Services: Laboratory","Lipid panel",14.42,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A10)","v":1}]
[10,"E119.00, Z7982, Z794",80069,"Primary","Diagnostic Services: Laboratory","Renal Function Panel",11.63,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A11)","v":2}]
[11,"E119.00, Z7982, Z794",81003,"Primary","Diagnostic Services: Laboratory","Urinalysis Auto W/O Scope",3.09,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A12)","v":2}]
[12,"E119.00, Z7982, Z794",82043,"Primary","Diagnostic Services: Laboratory","Microalbumin Quantitative",6.32,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A13)","v":1}]
[13,"E119.00, Z7982, Z794",82570,"Primary","Diagnostic Services: Laboratory","Assay of Urine Creatinine",5.79,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A14)","v":1}]
[14,"E119.00, Z7982, Z794",8290328279,"Pharmacy Retail","Medical Supplies","BD Ultrafine Insulin Syringes / 30G/ 0.5cc  [usage = 30 syringes per month]",42.66,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A15)","v":13}]
[15,"E119.00, Z7982, Z794",82947,"Primary","Diagnostic Services: Laboratory","Assay Glucose Blood Quant",5.73,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A16)","v":2}]
[16,"E119.00, Z7982, Z794",83036,"Primary","Diagnostic Services: Laboratory","Glycosylated Hemoglobin Test",10.85,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A17)","v":4}]
[17,"E119.00, Z7982, Z794",88222033,"Pharmacy Retail","Prescription Drugs: Branded","Insulin glargine 100 unit/ml injectable solution (Rx - 10ml vial)  [20 units QD; expires 28 days after first use]",275.51,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A18)","v":13}]
[18,"E119.00, Z7982, Z794",93104801,"Pharmacy Retail","Prescription Drugs: Generic","Metformin hydrochloride 500mg (Rx) [1 BID; #60 pills/month]",8.7100000000000009,"not used",true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A19)","v":0}]
[19,"E119.00, Z7982, Z794",93743801,"Pharmacy Retail","Prescription Drugs: Generic","Ramipril 10mg (Rx) [1 QD; #30 pills/month]",15.92,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A20)","v":13}]
[20,"E119.00, Z7982, Z794",97803,"Dietician","Professional Services: Primary Care","Med Nutrition Indiv Subseq",80,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A21)","v":2}]
[21,"E119.00, Z7982, Z794",98960,"Diabetes Educator","Professional Services: Primary Care","Self-mgmt educ & train 1 pt",99.9,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A22)","v":2}]
[22,"E119.00, Z7982, Z794",92014,"Ophthalmology","Professional Services: Specialist","Ophthalmological services: medical examination & evaluation, with initiation or continuation of diagnostic and treatment program, comprehensive, established patient, 1 or more visits",108.24,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A23)","v":1}]
[23,"E119.00, Z7982, Z794",99204,"Podiatry","Professional Services: Specialist","Office/Outpatient Visit New",165,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A24)","v":1}]
[24,"E119.00, Z7982, Z794",99214,"Primary","Professional Services: Primary Care","Office/Outpatient Visit Est",107.87,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A25)","v":4}]
[25,"E119.00, Z7982, Z794","OTC","Pharmacy Retail","Over-the-counter Drugs","Alcohol swabs (OTC - box of 100)  [usage = 3 wipes/day; 90 wipes/month]",2.6074999999999999,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A26)","v":13}]
[26,"E119.00, Z7982, Z794","OTC","Pharmacy Retail","Over-the-counter Drugs","Aspirin 81mg (OTC - bottle 100) [usage = 1 QD; #30 pills per month]",4.2725,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A27)","v":5}]
[27,"Z23",90471,"Primary","Preventive Services & Vaccines","Immunization Admin ADMIN",23,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A28)","v":1}]
[28,"Z23",90472,"Primary","Preventive Services & Vaccines","Immunization admin each add ",14.98,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A29)","v":1}]
[29,"Z23",90669,"Primary","Preventive Services & Vaccines","Pneumococcal vacc 7 val im",97.86,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A30)","v":1}]
[30,"Z23",90656,"Primary","Preventive Services & Vaccines","Flu Vaccine No Preserv 3 & >",14.27,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A31)","v":1}]
[31,null,310075190,"Pharmacy Retail","Prescription Drugs: Branded","CRESTOR 10MG TABLET (90 BOT) (NDC: 00310075190)",176.75,"not used",true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A32)","v":0}]
[32,null,93104901,"Pharmacy Retail","Prescription Drugs: Generic","METFORMIN HCL 850 MG TABLET",9.19,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A33)","v":13}]
[33,null,60505257909,"Pharmacy Retail","Prescription Drugs: Generic","Atorvastatin 20 MG tablet 90 CT",25.88,null,true,{"$f":"COUNTIF(DIABETES_TIMELINE!ServiceCode,A34)","v":4}]

{"sheet":"MATERNITY_SUMMARY","index":11,"n_rows":27,"n_cols":10,"rows_kept":27,"cut":false,"hidden":true,"merged":[]}
[]
[null,"Maternity Example: Summary of Subscriber and Plan Payments"]
[]
[null,{"$f":"BENEFIT_DESIGN!$B$6","v":"Plan 3"},"Allowed Amount",null,null,"Subscriber pays:"]
[null,"Benefit category","Allowed Amount (unrounded)","Allowed Amount (rounded)","Plan payment (unrounded)","Total subscriber payment","Subscriber-paid deductible","Subscriber-paid copayment","Subscriber-paid coinsurance","Non-covered and exclusions"]
[null,{"$f":"BENEFIT_DESIGN!B8","v":"Inpatient Hospital Care (Facility)"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B6)","v":8959.380000000001},{"$f":"MROUND(C6,IF(C6>=100,100,10))","v":9000},{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B6)","v":8959.380000000001},{"$f":"SUM(G6:J6)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B6)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B6)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B9","v":"Other Facility Services"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"MROUND(C7,IF(C7>=100,100,10))","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUM(G7:J7)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B7)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B7)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B10","v":"Emergency Department (Facility)"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B8)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B8)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B8)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B8)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B11","v":"Ambulance"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B9)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B9)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B9)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B9)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B12","v":"Professional Services: Primary Care"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B10)","v":198},200,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B10)","v":198},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B10)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B10)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B10)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B10)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B10)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B13","v":"Professional Services: Emergency Department"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B11)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B11)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B11)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B11)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B14","v":"Professional Services: Specialist"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B12)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B12)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B12)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B12)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B12)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B12)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B12)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B15","v":"Professional Services: Obstetric Care (Bundled)"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B13)","v":2394.1799999999998},2400,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B13)","v":1572.2799999999997},821.90000000000009,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B13)","v":821.90000000000009},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B13)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B13)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B16","v":"Professional Services: Procedures & Other"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B14)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B14)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B14)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B14)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B17","v":"Professional Services: Physical Therapy"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B15)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B15)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B15)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B15)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B18","v":"Diagnostic Services: Radiology"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B16)","v":163.99},200,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B16)","v":163.99},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B16)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B16)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B19","v":"Diagnostic Services: Laboratory"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B17)","v":882.13999999999987},900,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B17)","v":704.04},178.09999999999997,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B17)","v":178.09999999999997},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B17)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B17)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B17)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B17)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B20","v":"Prescription Drugs: Generic"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B18)","v":36.274999999999999},40,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B18)","v":36.274999999999999},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B18)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B18)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B18)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B18)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B18)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B21","v":"Prescription Drugs: Branded"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B19)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B19)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B19)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B19)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B22","v":"Over-the-counter Drugs"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B20)","v":60.017134523809524},60,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B20)","v":0},60.017134523809524,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B20)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B20)","v":60.017134523809524}]
[null,{"$f":"BENEFIT_DESIGN!B23","v":"Preventive Services & Vaccines"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B21)","v":37.269999999999996},40,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B21)","v":37.269999999999996},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B21)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B21)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B24","v":"Durable Medical Equipment"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B22)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B22)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B22)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B22)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B25","v":"Medical Supplies"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B23)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B23)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B23)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B23)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B26","v":"Over-the-counter Medical Supplies"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B24)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B24)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B24)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B24)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B27","v":"Other Items & Services"},{"$f":"SUMIFS(MATERNITY_TIMELINE!AllowedAmt,MATERNITY_TIMELINE!BenefitCategory,$B25)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!PlanPaymentAmt,MATERNITY_TIMELINE!BenefitCategory,$B25)","v":0},0,{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayDeduc,MATERNITY_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCopay,MATERNITY_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayCoins,MATERNITY_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(MATERNITY_TIMELINE!SubscriberPayNonCov,MATERNITY_TIMELINE!BenefitCategory,$B25)+SUMIFS(MATERNITY_TIMELINE!SubscriberPayExclusion,MATERNITY_TIMELINE!BenefitCategory,$B25)","v":0}]
[null,"Total (unrounded)",{"$f":"SUM(C6:C25)","v":12731.252134523809},null,{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(E6:E25)),\"ERROR\")","v":11671.234999999999},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(F6:F25)),\"ERROR\")","v":1060.0171345238095},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(G6:G25)),\"ERROR\")","v":1000},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(H6:H25)),\"ERROR\")","v":0},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(I6:I25)),\"ERROR\")","v":0},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(J6:J25)),\"ERROR\")","v":60.017134523809524}]
[null,"Total (rounded)",null,{"$f":"SUM(D6:D25)","v":12840},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",D27-F27),\"ERROR\")","v":11780},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(G27:J27)),\"ERROR\")","v":1060},{"$f":"IFERROR(IF(OR(BENEFIT_DESIGN_ERRORS!$D$34,BENEFIT_DESIGN_ERRORS!$E$34,BENEFIT_DESIGN_ERRORS!$H$34),\"ERROR\",MROUND(G26,10)),\"ERROR\")","v":1000},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$I$34,\"ERROR\",MROUND(H26,10)),\"ERROR\")","v":0},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$J$34,\"ERROR\",MROUND(I26,10)),\"ERROR\")","v":0},{"$f":"IFERROR(IF(OR(BENEFIT_DESIGN_ERRORS!$K$34,BENEFIT_DESIGN_ERRORS!$L$34,BENEFIT_DESIGN_ERRORS!$M$34),\"ERROR\",MROUND(J26,10)),\"ERROR\")","v":60}]

{"sheet":"MATERNITY_TIMELINE","index":12,"n_rows":56,"n_cols":50,"rows_kept":56,"cut":false,"hidden":false,"merged":[]}
[null,null,null,null,null,null,null,"Phase 1","Phase 2",null,"Phase 3",null,null,null,null,null,"Phase 4",null,null,"Phase 5","Phase 5: plan deductible",null,null,"Phase 5: Rx deductible",null,null,"Phase 5: optional deductible C",null,null,"Phase 5: optional deductible D",null,null,"Phase 5: benefit deductible",null,null,null,null,"Phase 6",null,null,null,"Phase 7",null,"Phase 8"]
["Claim number","Date","Calendar Month","Item or Service Code","Description","Benefit Category","Cost-sharing type","Allowed amount","Not covered","Covered amount","Monthly limit","Prior use (month)","subscriber pays because monthly limit exceeded","Annual limit","Prior use (annual)","subscriber pays because annual limit exceeded","Co-payment amount","Co-insurance rate","Co-insurance amount","Allowed amount after co-payment or co-insurance","Plan deductible applies","remaining plan deductible","subscriber pays toward plan deductible","Rx deductible applies","remaining Rx deductible","subscriber pays toward Rx deductible","deductible C applies","remaining deductible C","subscriber pays toward deductible C","deductible D applies","remaining deductible D","subscriber pays toward deductible D","benefit deductible applies","remaining benefit deductible","subscriber pays toward benefit deductible","subscriber pays toward any deductible","Covered amount remaining after deductibles","subscriber payment before OPL","OPL applies","amount subject to OPL","remaining OPL after subscriber payment","subscriber payment after OOP limit","plan payment","Not covered","Exclusions","Subscriber-paid copayment","Subscriber-paid coinsurance","Subscriber-paid deductible","Subscriber ChkSum","Allowable Charge ChkSum"]
[1,"2011-01-07",1,8,{"$f":"VLOOKUP(ServiceCode,MaternityFeeSchedule,6,FALSE)","v":"Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]"},{"$f":"VLOOKUP(ServiceCode,MaternityFeeSchedule,5,FALSE)","v":"Over-the-counter Drugs"},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCostSharing),FALSE)","v":"Not Covered"},{"$f":"VLOOKUP(ServiceCode,MaternityFeeSchedule,7,FALSE)","v":12.205466666666666},{"$f":"IF(CostSharingType=\"Not Covered\",AllowedAmt,0)","v":12.205466666666666},{"$f":"IF((NotCoveredAmt+AmtExceedMonthLimit+AmtExceedAnnualLimit)>0,0,AllowedAmt)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimithMonth),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimMonth,ClaimMonth,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(MonthLimit=0,0,IF(PriorUseMonth>=MonthLimit,AllowedAmt,0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimitAnnual),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(AnnualLimit=0,0,IF(PriorUseAnnual>=AnnualLimit,AllowedAmt,0))","v":0},{"$f":"IF(AmtExceedMonthLimit=0,IF(AmtExceedAnnualLimit=0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCopay),FALSE),0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCoins),FALSE)","v":0},{"$f":"IF(AmtExceedMonthLimit=0,IF(AmtExceedAnnualLimit=0,CoInsRate*CoveredAmt,0))","v":0},{"$f":"IF((CoveredAmt-CoPayAmount-CoInsAmount)<0,0,CoveredAmt-CoPayAmount-CoInsAmount)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,PlanDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingPlanDeduc,AllowedAmtAfterCopayCoins,RemainingPlanDeduc)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,RxDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingRxDeduc,AllowedAmtAfterCopayCoins,RemainingRxDeduc)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleCApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleC,AllowedAmtAfterCopayCoins,RemainingDeductibleC)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleDApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleD,AllowedAmtAfterCopayCoins,RemainingDeductibleD)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,BenefitCategory,BenefitCategory,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingBenefitDeduc,AllowedAmtAfterCopayCoins,RemainingBenefitDeduc)","v":0},{"$f":"PlanDeductiblePayment+RxDeductiblePayment+DeductibleCPayment+DeductibleDPayment+BenefitDeductiblePayment","v":0},{"$f":"MAX(0,CoveredAmt-PaymentTowardDeductibles)","v":0},{"$f":"PaymentTowardDeductibles+CoPayAmount+CoInsAmount","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitOOPLimitApplies),FALSE)=\"Yes\"","v":false},{"$f":"IF(OPLApplies,SubscriberPaymentBeforeOPL,0)","v":0},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OPLimit),FALSE)-SUMIFS(AmountSubjectToOPL,OPLApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},{"$f":"IF((CoveredAmt-SubscriberPaymentAfterOPL)<0,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":0},{"$f":"NotCoveredAmt","v":12.205466666666666},{"$f":"AmtExceedMonthLimit+AmtExceedAnnualLimit","v":0},{"$f":"IF(CoPayAmount<SubscriberPaymentAfterOPL,CoPayAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"IF(CoInsAmount<SubscriberPaymentAfterOPL,CoInsAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},{"$f":"SUM(AS3:AV3)=AP3","v":true},{"$f":"SUM(AQ3:AV3)=H3","v":true}]
[2,"2011-04-01",4,14,"Obstetric Panel","Diagnostic Services: Laboratory","Plan Deductible Only",42.75,0,42.75,"None",0,0,"None",0,0,0,0,0,42.75,true,1000,42.75,false,0,0,false,0,0,false,0,0,false,0,0,42.75,0,42.75,true,42.75,1000,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":42.75},{"$f":"IF(CoveredAmt<SubscriberPaymentAfterOPL,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":0},0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":42.75},true,true]
[3,"2011-04-01",4,30,"Detect agnt mult dna ampli ","Diagnostic Services: Laboratory","Plan Deductible Only",94,0,94,"None",0,0,"None",0,0,0,0,0,94,true,957.25,94,false,0,0,false,0,0,false,0,0,false,0,0,94,0,94,true,94,957.25,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":94},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":94},true,true]
[4,"2011-04-01",4,31,"Cytopath TBS C/V Manual","Diagnostic Services: Laboratory","Plan Deductible Only",12.64,0,12.64,"None",0,0,"None",0,0,0,0,0,12.64,true,863.25,12.64,false,0,0,false,0,0,false,0,0,false,0,0,12.64,0,12.64,true,12.64,863.25,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":12.64},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":12.64},true,true]
[5,"2011-04-01",4,28,"HIV-1","Diagnostic Services: Laboratory","Plan Deductible Only",15.48,0,15.48,"None",0,0,"None",0,0,0,0,0,15.48,true,850.61,15.48,false,0,0,false,0,0,false,0,0,false,0,0,15.48,0,15.48,true,15.48,850.61,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":15.48},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":15.48},true,true]
[6,"2011-04-01",4,12,"Routine Venipuncture","Diagnostic Services: Laboratory","Plan Deductible Only",4.17,0,4.17,"None",0,0,"None",0,0,0,0,0,4.17,true,835.13,4.17,false,0,0,false,0,0,false,0,0,false,0,0,4.17,0,4.17,true,4.17,835.13,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":4.17},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":4.17},true,true]
[7,"2011-04-01",4,35,"Urine Pregnancy Test","Diagnostic Services: Laboratory","Plan Deductible Only",9.06,0,9.06,"None",0,0,"None",0,0,0,0,0,9.06,true,830.96,9.06,false,0,0,false,0,0,false,0,0,false,0,0,9.06,0,9.06,true,9.06,830.96,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":9.06},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":9.06},true,true]
[8,"2011-04-01",4,6,"Obstetrical Care","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",2394.1799999999998,0,2394.1799999999998,"None",0,0,"None",0,0,0,0,0,2394.1799999999998,true,821.90000000000009,821.90000000000009,false,0,0,false,0,0,false,0,0,false,0,0,821.90000000000009,1572.2799999999997,821.90000000000009,true,821.90000000000009,821.90000000000009,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":821.90000000000009},1572.2799999999997,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":821.90000000000009},true,true]
[9,"2011-04-07",4,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",0,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[10,"2011-04-07",4,8,"Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]","Over-the-counter Drugs","Not Covered",12.205466666666666,12.205466666666666,0,"None",0,0,"None",1,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,12.205466666666666,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[11,"2011-05-27",5,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",1,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[12,"2011-06-24",6,15,"Alpha-fetoprotein serum","Diagnostic Services: Laboratory","Plan Deductible Only",17.53,0,17.53,"None",0,0,"None",0,0,0,0,0,17.53,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,17.53,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},17.53,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[13,"2011-06-24",6,16,"Assay of estriol","Diagnostic Services: Laboratory","Plan Deductible Only",23.82,0,23.82,"None",0,0,"None",0,0,0,0,0,23.82,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,23.82,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},23.82,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[14,"2011-06-24",6,25,"Chorionic gonadotropin test","Diagnostic Services: Laboratory","Plan Deductible Only",16.399999999999999,0,16.399999999999999,"None",0,0,"None",0,0,0,0,0,16.399999999999999,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,16.399999999999999,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},16.399999999999999,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[15,"2011-06-24",6,27,"Inhibin A","Diagnostic Services: Laboratory","Plan Deductible Only",17.43,0,17.43,"None",0,0,"None",0,0,0,0,0,17.43,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,17.43,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},17.43,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[16,"2011-06-24",6,37,"CFTR gene analysis, common variants","Diagnostic Services: Laboratory","Plan Deductible Only",561.73,0,561.73,"None",0,0,"None",0,0,0,0,0,561.73,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,561.73,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},561.73,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[17,"2011-06-24",6,12,"Routine Venipuncture","Diagnostic Services: Laboratory","Plan Deductible Only",4.17,0,4.17,"None",0,0,"None",1,0,0,0,0,4.17,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,4.17,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},4.17,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[18,"2011-06-24",6,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",2,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[19,"2011-07-06",7,8,"Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]","Over-the-counter Drugs","Not Covered",12.205466666666666,12.205466666666666,0,"None",0,0,"None",2,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,12.205466666666666,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[20,"2011-07-22",7,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",3,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[21,"2011-07-22",7,13,"OB US >/= 14 WKS SNGL FETUS","Diagnostic Services: Radiology","Plan Deductible Only",163.99,0,163.99,"None",0,0,"None",0,0,0,0,0,163.99,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,163.99,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},163.99,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[22,"2011-08-19",8,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",4,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[23,"2011-09-16",9,17,"Assay Glucose Blood Quant","Diagnostic Services: Laboratory","Plan Deductible Only",5.73,0,5.73,"None",0,0,"None",0,0,0,0,0,5.73,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,5.73,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},5.73,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[24,"2011-09-16",9,26,"Complete cbc w/auto diff wbc","Diagnostic Services: Laboratory","Plan Deductible Only",11.14,0,11.14,"None",0,0,"None",0,0,0,0,0,11.14,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,11.14,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},11.14,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[25,"2011-09-16",9,18,"Glucose Test","Diagnostic Services: Laboratory","Plan Deductible Only",5.14,0,5.14,"None",0,0,"None",0,0,0,0,0,5.14,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,5.14,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},5.14,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[26,"2011-09-16",9,12,"Routine Venipuncture","Diagnostic Services: Laboratory","Plan Deductible Only",4.17,0,4.17,"None",0,0,"None",2,0,0,0,0,4.17,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,4.17,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},4.17,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[27,"2011-09-16",9,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",5,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[28,"2011-09-30",9,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",1,0,"None",6,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[29,"2011-10-04",10,8,"Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]","Over-the-counter Drugs","Not Covered",12.205466666666666,12.205466666666666,0,"None",0,0,"None",3,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,12.205466666666666,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[30,"2011-10-14",10,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",7,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[31,"2011-10-20",10,9,"Birthing class","Preventive Services & Vaccines","No Cost Sharing",0,0,0,"None",0,0,"None",0,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[32,"2011-10-27",10,9,"Birthing class","Preventive Services & Vaccines","No Cost Sharing",0,0,0,"None",1,0,"None",1,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[33,"2011-10-28",10,29,{"$f":"VLOOKUP(ServiceCode,MaternityFeeSchedule,6,FALSE)","v":"Strep B DNA Amp Probe"},{"$f":"VLOOKUP(ServiceCode,MaternityFeeSchedule,5,FALSE)","v":"Diagnostic Services: Laboratory"},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCostSharing),FALSE)","v":"Plan Deductible Only"},{"$f":"VLOOKUP(ServiceCode,MaternityFeeSchedule,7,FALSE)","v":36.78},{"$f":"IF(CostSharingType=\"Not Covered\",AllowedAmt,0)","v":0},{"$f":"IF((NotCoveredAmt+AmtExceedMonthLimit+AmtExceedAnnualLimit)>0,0,AllowedAmt)","v":36.78},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimithMonth),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimMonth,ClaimMonth,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(MonthLimit=0,0,IF(PriorUseMonth>=MonthLimit,AllowedAmt,0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimitAnnual),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(AnnualLimit=0,0,IF(PriorUseAnnual>=AnnualLimit,AllowedAmt,0))","v":0},0,0,0,{"$f":"IF((CoveredAmt-CoPayAmount-CoInsAmount)<0,0,CoveredAmt-CoPayAmount-CoInsAmount)","v":36.78},true,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,PlanDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingPlanDeduc,AllowedAmtAfterCopayCoins,RemainingPlanDeduc)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,RxDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingRxDeduc,AllowedAmtAfterCopayCoins,RemainingRxDeduc)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleCApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleC,AllowedAmtAfterCopayCoins,RemainingDeductibleC)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleDApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleD,AllowedAmtAfterCopayCoins,RemainingDeductibleD)","v":0},false,{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,BenefitCategory,BenefitCategory,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingBenefitDeduc,AllowedAmtAfterCopayCoins,RemainingBenefitDeduc)","v":0},{"$f":"PlanDeductiblePayment+RxDeductiblePayment+DeductibleCPayment+DeductibleDPayment+BenefitDeductiblePayment","v":0},36.78,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},36.78,{"$f":"NotCoveredAmt","v":0},{"$f":"AmtExceedMonthLimit+AmtExceedAnnualLimit","v":0},{"$f":"IF(CoPayAmount<SubscriberPaymentAfterOPL,CoPayAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"IF(CoInsAmount<SubscriberPaymentAfterOPL,CoInsAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},{"$f":"SUM(AS35:AV35)=AP35","v":true},{"$f":"SUM(AQ35:AV35)=H35","v":true}]
[34,"2011-10-28",10,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",1,0,"None",8,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},{"$f":"IF(CoveredAmt<SubscriberPaymentAfterOPL,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":0},0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[35,"2011-10-28",10,10," Immunization Admin","Preventive Services & Vaccines","No Cost Sharing",23,0,23,"None",0,0,"None",0,0,0,0,0,23,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,23,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},23,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[36,"2011-10-28",10,11,"Flu Vaccine N0 Preserv 3 & >","Preventive Services & Vaccines","No Cost Sharing",14.27,0,14.27,"None",0,0,"None",0,0,0,0,0,14.27,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,14.27,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},14.27,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[37,"2011-11-01",11,9,"Birthing class","Preventive Services & Vaccines","No Cost Sharing",0,0,0,"None",0,0,"None",2,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[38,"2011-11-08",11,9,"Birthing class","Preventive Services & Vaccines","No Cost Sharing",0,0,0,"None",1,0,"None",3,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[39,"2011-11-11",11,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",9,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[40,"2011-11-18",11,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",1,0,"None",10,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[41,"2011-11-25",11,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",2,0,"None",11,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[42,"2011-12-02",12,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",12,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[43,"2011-12-09",12,36,"Inpatient Maternity Bundle (Bundled line items 4, 5, 34)","Inpatient Hospital Care (Facility)","Plan Deductible Only",8959.380000000001,0,8959.380000000001,"None",0,0,"None",0,0,0,0,0,8959.380000000001,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,8959.380000000001,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},8959.380000000001,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[44,"2011-12-09",12,32,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",1,0,"None",13,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[45,"2011-12-09",12,3,"Lactation class","Preventive Services & Vaccines","No Cost Sharing",0,0,0,"None",0,0,"None",0,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[46,"2011-12-10",12,38,"Initial hospital or birthing center care, per day, for E/M of normal newborn infant","Professional Services: Primary Care","Copayment Only",99,0,99,"None",0,0,"None",0,0,30,0,0,69,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,99,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},99,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[47,"2011-12-11",12,38,"Initial hospital or birthing center care, per day, for E/M of normal newborn infant","Professional Services: Primary Care","Copayment Only",99,0,99,"None",1,0,"None",1,0,30,0,0,69,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,99,30,true,30,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},99,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[48,"2011-12-11",12,7,"Docusate sodium (OTC) [1 pill QD]","Over-the-counter Drugs","Not Covered",11.195267857142857,11.195267857142857,0,"None",0,0,"None",0,0,0,0,0,0,false,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,false,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,11.195267857142857,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[49,"2011-12-11",12,2,"Ibuprofen 800mg (Rx) [1 pill Q8H PRN; 60 pills]","Prescription Drugs: Generic","Rx Deductible+Co-ins",11.6875,0,11.6875,"None",0,0,"None",0,0,0,0.1,1.16875,10.518750000000001,false,0,0,true,100,10.518750000000001,false,0,0,false,0,0,false,0,0,10.518750000000001,1.1687499999999993,11.6875,true,11.6875,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},11.6875,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[50,"2011-12-11",12,1,"Oxycodone/APAP 5mg/325mg (Rx) [1 pill Q6H PRN; 15 pills]","Prescription Drugs: Generic","Rx Deductible+Co-ins",6.45,0,6.45,"None",0,0,"None",0,0,0,0.1,0.64500000000000002,5.8049999999999997,false,0,0,true,89.481250000000003,5.8049999999999997,false,0,0,false,0,0,false,0,0,5.8049999999999997,0.64500000000000046,6.4499999999999993,true,6.4499999999999993,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},6.45,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[51,"2011-12-23",12,33,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",0,0,"None",0,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[52,"2011-12-11",{"$f":"MONTH(B54)","v":12},2,"Ibuprofen 800mg (Rx) [1 pill Q8H PRN; 60 pills]","Prescription Drugs: Generic","Rx Deductible+Co-ins",11.6875,0,11.6875,"None",1,0,"None",1,0,0,0.1,1.16875,10.518750000000001,false,0,0,true,83.676249999999996,10.518750000000001,false,0,0,false,0,0,false,0,0,10.518750000000001,1.1687499999999993,11.6875,true,11.6875,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},11.6875,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[53,"2011-12-11",12,1,"Oxycodone/APAP 5mg/325mg (Rx) [1 pill Q6H PRN; 15 pills]","Prescription Drugs: Generic","Rx Deductible+Co-ins",6.45,0,6.45,"None",1,0,"None",1,0,0,0.1,0.64500000000000002,5.8049999999999997,false,0,0,true,73.157499999999999,5.8049999999999997,false,0,0,false,0,0,false,0,0,5.8049999999999997,0.64500000000000046,6.4499999999999993,true,6.4499999999999993,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},6.45,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[54,"2011-12-23",12,33,"Office/Outpatient Visit Est","Professional Services: Obstetric Care (Bundled)","Plan Deductible Only",0,0,0,"None",1,0,"None",1,0,0,0,0,0,true,0,0,false,0,0,false,0,0,false,0,0,false,0,0,0,0,0,true,0,0,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]

{"sheet":"MATERNITY_LINE_ITEM","index":13,"n_rows":41,"n_cols":10,"rows_kept":41,"cut":false,"hidden":true,"merged":[]}
["Item or Service Code","Diagnosis Code \n(ICD-10)","CPT©, HCPCS, or\nOther Billing Code","Provider\nType","Benefit Category","Description","Allowed\nAmount","Notes","Valid Benefit Category","Timeline Count"]
[1,null,378710401,"Pharmacy Retail","Prescription Drugs: Generic","Oxycodone/APAP 5mg/325mg (Rx) [1 pill Q6H PRN; 15 pills]",6.45,null,{"$f":"IF(ISERROR(VLOOKUP(E2,BenefitCategoryList,1,FALSE)),FALSE,TRUE)","v":true},{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A2)","v":2}]
[2,null,591346601,"Pharmacy Retail","Prescription Drugs: Generic","Ibuprofen 800mg (Rx) [1 pill Q8H PRN; 60 pills]",11.6875,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A3)","v":2}]
[3,"O80, Z370","S9443","Inpatient Facility","Preventive Services & Vaccines","Lactation class",0,"Included in hospital rate**",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A4)","v":1}]
[4,"O80, Z370",795,"Inpatient Facility","Inpatient Hospital Care (Facility)","Normal newborn",1756,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A5)","v":0}]
[5,"O80, Z370",1967,"Anesthesiology","Professional Services: Procedures & Other","Anesth/analg vag delivery",1008,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A6)","v":0}]
[6,"O80, Z370",59400,"OBGYN","Professional Services: Obstetric Care (Bundled)","Obstetrical Care",2394.1799999999998,"59400 - Global OB package description/code",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A7)","v":1}]
[7,null,"OTC","Pharmacy Retail","Over-the-counter Drugs","Docusate sodium (OTC) [1 pill QD]",11.195267857142857,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A8)","v":1}]
[8,null,"OTC","Pharmacy Retail","Over-the-counter Drugs","Prenatal Vitamins (OTC - Bottle of 100) [1 pill daily; 30 pills/month]",12.205466666666666,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A9)","v":4}]
[9,null,"S9442","Alternative Provider","Preventive Services & Vaccines","Birthing class",0,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A10)","v":4}]
[10,"Z23",90471,"OBGYN","Preventive Services & Vaccines"," Immunization Admin",23,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A11)","v":1}]
[11,"Z23",90656,"OBGYN","Preventive Services & Vaccines","Flu Vaccine N0 Preserv 3 & >",14.27,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A12)","v":1}]
[12,"Z3400",36415,"OBGYN","Diagnostic Services: Laboratory","Routine Venipuncture",4.17,"Cystic fibrosis screen",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A13)","v":3}]
[13,"Z3400",76805,"Radiology","Diagnostic Services: Radiology","OB US >/= 14 WKS SNGL FETUS",163.99,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A14)","v":1}]
[14,"Z3400",80055,"OBGYN","Diagnostic Services: Laboratory","Obstetric Panel",42.75,"80055 - Global OB panel code",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A15)","v":1}]
[15,"Z3400",82105,"OBGYN","Diagnostic Services: Laboratory","Alpha-fetoprotein serum",17.53,"Maternal serum quad screen",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A16)","v":1}]
[16,"Z3400",82677,"OBGYN","Diagnostic Services: Laboratory","Assay of estriol",23.82,"Maternal serum quad screen",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A17)","v":1}]
[17,"Z3400",82947,"OBGYN","Diagnostic Services: Laboratory","Assay Glucose Blood Quant",5.73,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A18)","v":1}]
[18,"Z3400",82950,"OBGYN","Diagnostic Services: Laboratory","Glucose Test",5.14,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A19)","v":1}]
[19,"Z3400",83891,"OBGYN","Diagnostic Services: Laboratory","Molecule isolate nucleic",null,"Not used",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A20)","v":0}]
[20,"Z3400",83900,"OBGYN","Diagnostic Services: Laboratory","Molecule nucleic ampli 2 seq",null,"Not used",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A21)","v":0}]
[21,"Z3400",83901,"OBGYN","Diagnostic Services: Laboratory","Molecule nucleic ampli addon",null,"Not used",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A22)","v":0}]
[22,"Z3400",83909,"OBGYN","Diagnostic Services: Laboratory","Nucleic acid high resolute",null,"Not used",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A23)","v":0}]
[23,"Z3400",83912,"OBGYN","Diagnostic Services: Laboratory","Genetic examination",null,"Not used",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A24)","v":0}]
[24,"Z3400",83914,"OBGYN","Diagnostic Services: Laboratory","Mutation ident ola/sbce/aspe",265.06,"Not used",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A25)","v":0}]
[25,"Z3400",84702,"OBGYN","Diagnostic Services: Laboratory","Chorionic gonadotropin test",16.399999999999999,"Maternal serum quad screen",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A26)","v":1}]
[26,"Z3400",85025,"OBGYN","Diagnostic Services: Laboratory","Complete cbc w/auto diff wbc",11.14,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A27)","v":1}]
[27,"Z3400",86336,"OBGYN","Diagnostic Services: Laboratory","Inhibin A",17.43,"Maternal serum quad screen",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A28)","v":1}]
[28,"Z3400",86701,"OBGYN","Diagnostic Services: Laboratory","HIV-1",15.48,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A29)","v":1}]
[29,"Z3400",87653,"OBGYN","Diagnostic Services: Laboratory","Strep B DNA Amp Probe",36.78,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A30)","v":1}]
[30,"Z3400",87801,"OBGYN","Diagnostic Services: Laboratory","Detect agnt mult dna ampli ",94,"Gonorrhea / Chlamydia screen",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A31)","v":1}]
[31,"Z3400",88164,"OBGYN","Diagnostic Services: Laboratory","Cytopath TBS C/V Manual",12.64,"Pap smear",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A32)","v":1}]
[32,"Z3400",59400,"OBGYN","Professional Services: Obstetric Care (Bundled)","Office/Outpatient Visit Est",null,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A33)","v":14}]
[33,"Z392",59400,"OBGYN","Professional Services: Obstetric Care (Bundled)","Office/Outpatient Visit Est",null,"Post partum visit",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A34)","v":2}]
[34,"Z3800",775,"Inpatient Facility","Inpatient Hospital Care (Facility)","Vaginal delivery w/o complicating diagnoses",6195.38,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A35)","v":0}]
[35,"Z3201",81025,"OBGYN","Diagnostic Services: Laboratory","Urine Pregnancy Test",9.06,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A36)","v":1}]
[36,null,null,"Inpatient Facility","Inpatient Hospital Care (Facility)","Inpatient Maternity Bundle (Bundled line items 4, 5, 34)",8959.380000000001,"see individual line items on Line Item Maternity tab",true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A37)","v":1}]
[37,"Z3400",81220,"OBGYN","Diagnostic Services: Laboratory","CFTR gene analysis, common variants",561.73,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A38)","v":1}]
[38,null,99460,"Inpatient Professional","Professional Services: Primary Care","Initial hospital or birthing center care, per day, for E/M of normal newborn infant",99,null,true,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A39)","v":2}]
[39,null,59409,"Inpatient Professional","Professional Services: ","Vaginal delivery only (with or without episiotomy and/or forceps)",1186.78,null,false,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A40)","v":0}]
[40,null,59410,"Inpatient Professional",null,"Vaginal delivery with postpartum care",1450.41,null,false,{"$f":"COUNTIF(MATERNITY_TIMELINE!ServiceCode,A41)","v":0}]

{"sheet":"FRACTURE_SUMMARY","index":14,"n_rows":27,"n_cols":10,"rows_kept":27,"cut":false,"hidden":true,"merged":[]}
[]
[null,"Foot Fracture Example: Summary of Subscriber and Plan Payments"]
[]
[null,{"$f":"BENEFIT_DESIGN!$B$6","v":"Plan 3"},"Allowed Amount",null,null,"Subscriber pays:"]
[null,"Benefit category","Allowed Amount (unrounded)","Allowed Amount (rounded)","Plan payment (unrounded)","Total subscriber payment","Subscriber-paid deductible","Subscriber-paid copayment","Subscriber-paid coinsurance","Non-covered and exclusions"]
[null,{"$f":"BENEFIT_DESIGN!B8","v":"Inpatient Hospital Care (Facility)"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"MROUND(C6,IF(C6>=100,100,10))","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUM(G6:J6)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B6)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B6)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B6)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B9","v":"Other Facility Services"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B7)","v":37.14},{"$f":"MROUND(C7,IF(C7>=100,100,10))","v":40},{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUM(G7:J7)","v":37.14},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B7)","v":37.14},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B7)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B7)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B7)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B10","v":"Emergency Department (Facility)"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B8)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B8)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B8)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B8)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B8)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B11","v":"Ambulance"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B9)","v":754.55000000000007},800,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B9)","v":654.54999999999995},100,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B9)","v":100},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B9)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B9)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B9)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B12","v":"Professional Services: Primary Care"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B10)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B10)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B10)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B10)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B10)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B10)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B10)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B13","v":"Professional Services: Emergency Department"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B11)","v":557.41000000000008},600,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B11)","v":557.41000000000008},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B11)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B11)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B11)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B14","v":"Professional Services: Specialist"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B12)","v":293.37},300,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B12)","v":0},293.37,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B12)","v":293.37},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B12)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B12)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B12)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B12)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B15","v":"Professional Services: Obstetric Care (Bundled)"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B13)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B13)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B13)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B13)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B13)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B16","v":"Professional Services: Procedures & Other"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B14)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B14)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B14)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B14)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B14)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B17","v":"Professional Services: Physical Therapy"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B15)","v":215.76},200,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B15)","v":0},215.76,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B15)","v":215.76},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B15)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B15)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B15)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B18","v":"Diagnostic Services: Radiology"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B16)","v":30.2},30,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B16)","v":0},30.2,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B16)","v":30.2},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B16)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B16)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B16)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B19","v":"Diagnostic Services: Laboratory"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B17)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B17)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B17)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B17)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B17)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B17)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B17)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B20","v":"Prescription Drugs: Generic"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B18)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B18)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B18)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B18)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B18)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B18)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B18)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B21","v":"Prescription Drugs: Branded"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B19)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B19)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B19)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B19)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B19)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B22","v":"Over-the-counter Drugs"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B20)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B20)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B20)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B20)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B20)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B23","v":"Preventive Services & Vaccines"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B21)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B21)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B21)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B21)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B21)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B24","v":"Durable Medical Equipment"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B22)","v":36.61},40,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B22)","v":0},36.61,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B22)","v":36.61},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B22)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B22)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B22)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B25","v":"Medical Supplies"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B23)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B23)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B23)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B23)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B23)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B26","v":"Over-the-counter Medical Supplies"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B24)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B24)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B24)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B24)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B24)","v":0}]
[null,{"$f":"BENEFIT_DESIGN!B27","v":"Other Items & Services"},{"$f":"SUMIFS(FRACTURE_TIMELINE!AllowedAmt,FRACTURE_TIMELINE!BenefitCategory,$B25)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!PlanPaymentAmt,FRACTURE_TIMELINE!BenefitCategory,$B25)","v":0},0,{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayDeduc,FRACTURE_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCopay,FRACTURE_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayCoins,FRACTURE_TIMELINE!BenefitCategory,$B25)","v":0},{"$f":"SUMIFS(FRACTURE_TIMELINE!SubscriberPayNonCov,FRACTURE_TIMELINE!BenefitCategory,$B25)+SUMIFS(FRACTURE_TIMELINE!SubscriberPayExclusion,FRACTURE_TIMELINE!BenefitCategory,$B25)","v":0}]
[null,"Total (unrounded)",{"$f":"SUM(C6:C25)","v":1925.0400000000002},null,{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(E6:E25)),\"ERROR\")","v":1211.96},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(F6:F25)),\"ERROR\")","v":713.08},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(G6:G25)),\"ERROR\")","v":713.08},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(H6:H25)),\"ERROR\")","v":0},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(I6:I25)),\"ERROR\")","v":0},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(J6:J25)),\"ERROR\")","v":0}]
[null,"Total (rounded)",null,{"$f":"SUM(D6:D25)","v":2010},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",D27-F27),\"ERROR\")","v":1300},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$C$34,\"ERROR\",SUM(G27:J27)),\"ERROR\")","v":710},{"$f":"IFERROR(IF(OR(BENEFIT_DESIGN_ERRORS!$D$34,BENEFIT_DESIGN_ERRORS!$E$34,BENEFIT_DESIGN_ERRORS!$H$34),\"ERROR\",MROUND(G26,10)),\"ERROR\")","v":710},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$I$34,\"ERROR\",MROUND(H26,10)),\"ERROR\")","v":0},{"$f":"IFERROR(IF(BENEFIT_DESIGN_ERRORS!$J$34,\"ERROR\",MROUND(I26,10)),\"ERROR\")","v":0},{"$f":"IFERROR(IF(OR(BENEFIT_DESIGN_ERRORS!$K$34,BENEFIT_DESIGN_ERRORS!$L$34,BENEFIT_DESIGN_ERRORS!$M$34),\"ERROR\",MROUND(J26,10)),\"ERROR\")","v":0}]

{"sheet":"FRACTURE_TIMELINE","index":15,"n_rows":18,"n_cols":50,"rows_kept":18,"cut":false,"hidden":false,"merged":[]}
[null,null,null,null,null,null,null,"Phase 1","Phase 2",null,"Phase 3",null,null,null,null,null,"Phase 4",null,null,"Phase 5","Phase 5: plan deductible",null,null,"Phase 5: Rx deductible",null,null,"Phase 5: optional deductible C",null,null,"Phase 5: optional deductible D",null,null,"Phase 5: benefit deductible",null,null,null,null,"Phase 6",null,null,null,"Phase 7",null,"Phase 8"]
["Claim number","Date","Calendar Month","Item or Service Code","Description","Benefit Category","Cost-sharing type","Allowed amount","Not covered","Covered amount","Monthly limit","Prior use (month)","subscriber pays because monthly limit exceeded","Annual limit","Prior use (annual)","subscriber pays because annual limit exceeded","Co-payment amount","Co-insurance rate","Co-insurance amount","Allowed amount after co-payment or co-insurance","Plan deductible applies","remaining plan deductible","subscriber pays toward plan deductible","Rx deductible applies","remaining Rx deductible","subscriber pays toward Rx deductible","deductible C applies","remaining deductible C","subscriber pays toward deductible C","deductible D applies","remaining deductible D","subscriber pays toward deductible D","benefit deductible applies","remaining benefit deductible","subscriber pays toward benefit deductible","subscriber pays toward any deductible","Covered amount remaining after deductibles","subscriber payment before OPL","OPL applies","amount subject to OPL","remaining OPL after subscriber payment","subscriber payment after OOP limit","plan payment","Not covered","Exclusions","Subscriber-paid copayment","Subscriber-paid coinsurance","Subscriber-paid deductible","Subscriber ChkSum","Allowable Charge ChkSum"]
[1,"2014-06-02",6,2,{"$f":"VLOOKUP(ServiceCode,FractureFeeSchedule,6,FALSE)","v":"Ground mileage, per statute mile"},{"$f":"VLOOKUP(ServiceCode,FractureFeeSchedule,5,FALSE)","v":"Ambulance"},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCostSharing),FALSE)","v":"Deductible C Only"},{"$f":"VLOOKUP(ServiceCode,FractureFeeSchedule,7,FALSE)","v":75.95},{"$f":"IF(CostSharingType=\"Not Covered\",AllowedAmt,0)","v":0},{"$f":"IF((NotCoveredAmt+AmtExceedMonthLimit+AmtExceedAnnualLimit)>0,0,AllowedAmt)","v":75.95},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimithMonth),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimMonth,ClaimMonth,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(MonthLimit=0,0,IF(PriorUseMonth>=MonthLimit,AllowedAmt,0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitLimitAnnual),FALSE)","v":"None"},{"$f":"COUNTIFS(ServiceCode,ServiceCode,ClaimNumber,\"<\"&ClaimNumber)","v":0},{"$f":"IF(AnnualLimit=0,0,IF(PriorUseAnnual>=AnnualLimit,AllowedAmt,0))","v":0},{"$f":"IF(AmtExceedMonthLimit=0,IF(AmtExceedAnnualLimit=0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCopay),FALSE),0))","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitCoins),FALSE)","v":0},{"$f":"IF(AmtExceedMonthLimit=0,IF(AmtExceedAnnualLimit=0,CoInsRate*CoveredAmt,0))","v":0},{"$f":"IF((CoveredAmt-CoPayAmount-CoInsAmount)<0,0,CoveredAmt-CoPayAmount-CoInsAmount)","v":75.95},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(PlanDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,PlanDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingPlanDeduc,AllowedAmtAfterCopayCoins,RemainingPlanDeduc)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(RxDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,RxDeductibleApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingRxDeduc,AllowedAmtAfterCopayCoins,RemainingRxDeduc)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)>0","v":true},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleC),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleCApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":100},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleC,AllowedAmtAfterCopayCoins,RemainingDeductibleC)","v":75.95},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OptDeductibleD),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,DeductibleDApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingDeductibleD,AllowedAmtAfterCopayCoins,RemainingDeductibleD)","v":0},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)>0","v":false},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitDeductible),FALSE)-SUMIFS(AllowedAmtAfterCopayCoins,BenefitCategory,BenefitCategory,ClaimNumber,\"<\"&ClaimNumber))","v":0},{"$f":"IF(AllowedAmtAfterCopayCoins<RemainingBenefitDeduc,AllowedAmtAfterCopayCoins,RemainingBenefitDeduc)","v":0},{"$f":"PlanDeductiblePayment+RxDeductiblePayment+DeductibleCPayment+DeductibleDPayment+BenefitDeductiblePayment","v":75.95},{"$f":"MAX(0,CoveredAmt-PaymentTowardDeductibles)","v":0},{"$f":"PaymentTowardDeductibles+CoPayAmount+CoInsAmount","v":75.95},{"$f":"VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(BenefitOOPLimitApplies),FALSE)=\"Yes\"","v":true},{"$f":"IF(OPLApplies,SubscriberPaymentBeforeOPL,0)","v":75.95},{"$f":"MAX(0,VLOOKUP(BenefitCategory,BenefitDesignTable,COLUMN(OPLimit),FALSE)-SUMIFS(AmountSubjectToOPL,OPLApplies,TRUE,ClaimNumber,\"<\"&ClaimNumber))","v":1000},{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":75.95},{"$f":"IF((CoveredAmt-SubscriberPaymentAfterOPL)<0,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":0},{"$f":"NotCoveredAmt","v":0},{"$f":"AmtExceedMonthLimit+AmtExceedAnnualLimit","v":0},{"$f":"IF(CoPayAmount<SubscriberPaymentAfterOPL,CoPayAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"IF(CoInsAmount<SubscriberPaymentAfterOPL,CoInsAmount,SubscriberPaymentAfterOPL)","v":0},{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":75.95},{"$f":"SUM(AS3:AV3)=AP3","v":true},{"$f":"SUM(AQ3:AV3)=H3","v":true}]
[{"$f":"A3+1","v":2},"2014-06-02",6,18,"Ambulance service, basic life support, emergency transport (bls-emergency)","Ambulance","Deductible C Only",516.6,0,516.6,"None",0,0,"None",0,0,0,0,0,516.6,false,0,0,false,0,0,true,24.049999999999997,24.049999999999997,false,0,0,false,0,0,24.049999999999997,492.55,24.049999999999997,true,24.049999999999997,924.05,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":24.049999999999997},{"$f":"IF(CoveredAmt<SubscriberPaymentAfterOPL,0,CoveredAmt-SubscriberPaymentAfterOPL)","v":492.55},0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":24.049999999999997},true,true]
[3,"2014-06-02",6,4,"Emergency department visit for evaluation and management of patient, which req 3 key components. Usually, presenting problem(s) are high severity, & require urgent physician evaluation but do not pose","Professional Services: Emergency Department","Deductible C Only",271.37,0,271.37,"None",0,0,"None",0,0,0,0,0,271.37,false,0,0,false,0,0,true,0,0,false,0,0,false,0,0,0,271.37,0,true,0,900,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},271.37,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[4,"2014-06-02",6,5,"Radiologic examination, foot; complete, minimum of 3 views","Professional Services: Emergency Department","Deductible C Only",33.92,0,33.92,"None",0,0,"None",0,0,0,0,0,33.92,false,0,0,false,0,0,true,0,0,false,0,0,false,0,0,0,33.92,0,true,0,900,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},33.92,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[5,"2014-06-02",6,6,"Closed treatment of metatarsal fracture; without manipulation, each","Professional Services: Emergency Department","Deductible C Only",252.12,0,252.12,"None",0,0,"None",0,0,0,0,0,252.12,false,0,0,false,0,0,true,0,0,false,0,0,false,0,0,0,252.12,0,true,0,900,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},252.12,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[6,"2014-06-02",6,19,"Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf","Ambulance","Deductible C Only",162,0,162,"None",0,0,"None",0,0,0,0,0,162,false,0,0,false,0,0,true,0,0,false,0,0,false,0,0,0,162,0,true,0,900,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":0},162,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":0},true,true]
[7,"2014-06-02",6,9,"Crutches, underarm, other than wood, adjustable or fixed, pair, with pads, tips, and handgrips","Durable Medical Equipment","Plan Deductible Only",36.61,0,36.61,"None",0,0,"None",0,0,0,0,0,36.61,true,1000,36.61,false,0,0,false,0,0,false,0,0,false,0,0,36.61,0,36.61,true,36.61,900,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":36.61},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":36.61},true,true]
[8,"2014-06-16",6,11,"Office or other outpatient visit for the evaluation and management of a new patient, which requires at least 3 key components. Physicians typically spend 30 minutes face-to-face with the patient.","Professional Services: Specialist","Plan Deductible Only",109.78,0,109.78,"None",0,0,"None",0,0,0,0,0,109.78,true,963.39,109.78,false,0,0,false,0,0,false,0,0,false,0,0,109.78,0,109.78,true,109.78,863.39,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":109.78},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":109.78},true,true]
[9,"2014-06-16",6,12,"Application of short leg cast (below knee to toes);","Professional Services: Specialist","Plan Deductible Only",110.59,0,110.59,"None",0,0,"None",0,0,0,0,0,110.59,true,853.61,110.59,false,0,0,false,0,0,false,0,0,false,0,0,110.59,0,110.59,true,110.59,753.61,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":110.59},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":110.59},true,true]
[10,"2014-06-16",6,13,"Cast supplies, short leg cast, adult (11 years +), fiberglass","Other Facility Services","Plan Deductible Only",37.14,0,37.14,"None",0,0,"None",0,0,0,0,0,37.14,true,743.02,37.14,false,0,0,false,0,0,false,0,0,false,0,0,37.14,0,37.14,true,37.14,643.02,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":37.14},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":37.14},true,true]
[11,"2014-07-28",7,14,"Radiologic examination, foot; 2 views","Diagnostic Services: Radiology","Plan Deductible Only",30.2,0,30.2,"None",0,0,"None",0,0,0,0,0,30.2,true,705.88,30.2,false,0,0,false,0,0,false,0,0,false,0,0,30.2,0,30.2,true,30.2,605.88,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":30.2},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":30.2},true,true]
[12,"2014-07-28",7,15,"Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of 3 key components. Physicians typically spend 15 minutes face-to-face with the","Professional Services: Specialist","Plan Deductible Only",73,0,73,"None",0,0,"None",0,0,0,0,0,73,true,675.68000000000006,73,false,0,0,false,0,0,false,0,0,false,0,0,73,0,73,true,73,575.68000000000006,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":73},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":73},true,true]
[13,"2014-08-04",8,16,"Physical therapy evaluation","Professional Services: Physical Therapy","Plan Deductible Only",75,0,75,"None",0,0,"None",0,0,0,0,0,75,true,602.68000000000006,75,false,0,0,false,0,0,false,0,0,false,0,0,75,0,75,true,75,502.68,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":75},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":75},true,true]
[14,"2014-08-04",8,17,"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility","Professional Services: Physical Therapy","Plan Deductible Only",46.92,0,46.92,"None",0,0,"None",0,0,0,0,0,46.92,true,527.68000000000006,46.92,false,0,0,false,0,0,false,0,0,false,0,0,46.92,0,46.92,true,46.92,427.68000000000006,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":46.92},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":46.92},true,true]
[15,"2014-08-11",8,17,"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility","Professional Services: Physical Therapy","Plan Deductible Only",46.92,0,46.92,"None",1,0,"None",1,0,0,0,0,46.92,true,480.76,46.92,false,0,0,false,0,0,false,0,0,false,0,0,46.92,0,46.92,true,46.92,380.7600000000001,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":46.92},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":46.92},true,true]
[16,"2014-08-18",8,17,"Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility","Professional Services: Physical Therapy","Plan Deductible Only",46.92,0,46.92,"None",2,0,"None",2,0,0,0,0,46.92,true,433.84000000000003,46.92,false,0,0,false,0,0,false,0,0,false,0,0,46.92,0,46.92,true,46.92,333.84000000000015,{"$f":"IF(OPLApplies,IF(AmountSubjectToOPL<RemainingOPL,AmountSubjectToOPL,RemainingOPL),SubscriberPaymentBeforeOPL)","v":46.92},0,0,0,0,0,{"$f":"SubscriberPaymentAfterOPL-SubscriberPayCopay-SubscriberPayCoins","v":46.92},true,true]

{"sheet":"FRACTURE_LINE_ITEM","index":16,"n_rows":15,"n_cols":10,"rows_kept":15,"cut":false,"hidden":true,"merged":[]}
["Item or Service Code","Diagnosis Code \n(ICD-10)","CPT©, HCPCS, or\nOther Billing Code","Provider\nType","Benefit Category","Description","Allowed\nAmount","Notes","Valid Benefit Category","Timeline Count"]
[2,"S99929A","A0425","Ambulance (land)","Ambulance","Ground mileage, per statute mile",75.95,null,{"$f":"IF(ISERROR(VLOOKUP(E2,BenefitCategoryList,1,FALSE)),FALSE,TRUE)","v":true},{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A2)","v":1}]
[4,"S92353A",99284,"Outpatient Hospital","Professional Services: Emergency Department","Emergency department visit for evaluation and management of patient, which req 3 key components. Usually, presenting problem(s) are high severity, & require urgent physician evaluation but do not pose",271.37,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A3)","v":1}]
[5,"S92353A",73630,"Outpatient Hospital","Professional Services: Emergency Department","Radiologic examination, foot; complete, minimum of 3 views",33.92,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A4)","v":1}]
[6,"S92353A",28470,"Outpatient Hospital","Professional Services: Emergency Department","Closed treatment of metatarsal fracture; without manipulation, each",252.12,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A5)","v":1}]
[9,null,"E0114","Pharmacy Retail","Durable Medical Equipment","Crutches, underarm, other than wood, adjustable or fixed, pair, with pads, tips, and handgrips",36.61,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A6)","v":1}]
[11,"S92353A",99203,"Outpatient Hospital","Professional Services: Specialist","Office or other outpatient visit for the evaluation and management of a new patient, which requires at least 3 key components. Physicians typically spend 30 minutes face-to-face with the patient.",109.78,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A7)","v":1}]
[12,"S92353A",29405,"Outpatient Hospital","Professional Services: Specialist","Application of short leg cast (below knee to toes);",110.59,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A8)","v":1}]
[13,"S92353A","Q4038","Outpatient Hospital","Other Facility Services","Cast supplies, short leg cast, adult (11 years +), fiberglass",37.14,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A9)","v":1}]
[14,"S92353A",73600,"Primary","Diagnostic Services: Radiology","Radiologic examination, foot; 2 views",30.2,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A10)","v":1}]
[15,"S92353A",99213,"Primary","Professional Services: Specialist","Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of 3 key components. Physicians typically spend 15 minutes face-to-face with the",73,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A11)","v":1}]
[16,"S92353A",97001,"Physical Therapy","Professional Services: Physical Therapy","Physical therapy evaluation",75,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A12)","v":1}]
[17,"S92353A",97110,"Physical Therapy","Professional Services: Physical Therapy","Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility",46.92,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A13)","v":3}]
[18,null,"A0429","Ambulance (land)","Ambulance","Ambulance service, basic life support, emergency transport (bls-emergency)",516.6,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A14)","v":1}]
[19,null,"L4387","Outpatient Hospital","Ambulance","Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf",162,null,true,{"$f":"COUNTIF(FRACTURE_TIMELINE!ServiceCode,A15)","v":1}]

{"sheet":"PLAN_INPUT_DATA","index":17,"n_rows":10,"n_cols":146,"rows_kept":10,"cut":false,"hidden":true,"merged":[]}
[]
[null,"This worksheet contains the benefit parameters for multiple plans."]
[null,"You can copy and paste data for individual plans from an external source starting on row 8."]
[]
[]
[null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(G5)+2)/7+1)","v":"Inpatient Hospital Care (Facility)"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(N5)+2)/7+1)","v":"Other Facility Services"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(U5)+2)/7+1)","v":"Emergency Department (Facility)"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(AB5)+2)/7+1)","v":"Ambulance"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(AI5)+2)/7+1)","v":"Professional Services: Primary Care"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(AP5)+2)/7+1)","v":"Professional Services: Emergency Department"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(AW5)+2)/7+1)","v":"Professional Services: Specialist"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(BD5)+2)/7+1)","v":"Professional Services: Obstetric Care (Bundled)"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(BK5)+2)/7+1)","v":"Professional Services: Procedures & Other"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(BR5)+2)/7+1)","v":"Professional Services: Physical Therapy"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(BY5)+2)/7+1)","v":"Diagnostic Services: Radiology"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(CF5)+2)/7+1)","v":"Diagnostic Services: Laboratory"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(CM5)+2)/7+1)","v":"Prescription Drugs: Generic"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(CT5)+2)/7+1)","v":"Prescription Drugs: Branded"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(DA5)+2)/7+1)","v":"Over-the-counter Drugs"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(DH5)+2)/7+1)","v":"Preventive Services & Vaccines"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(DO5)+2)/7+1)","v":"Durable Medical Equipment"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(DV5)+2)/7+1)","v":"Medical Supplies"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(EC5)+2)/7+1)","v":"Over-the-counter Medical Supplies"},null,null,null,null,null,null,{"$f":"INDEX(BenefitCategoryList,(COLUMN(EJ5)+2)/7+1)","v":"Other Items & Services"}]
["PLAN_ID","Plan deductible","Rx deductible","Deductible C","Deductible D","OOP Limit","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies","Cost sharing Type","Benefit Deductible","Co-payment","Co-insurance","Monthly Limits","Annual Limits","OOP Limit Applies"]
["Plan 1",null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered",null,null,null,null,null,null,"Not Covered"]
["Plan 2",1000,null,null,null,2000,"Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Not Covered",null,null,null,null,null,null,"No Cost Sharing",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Not Covered",null,null,null,null,null,null,"Not Covered"]
["Plan 3",1000,100,500,null,1000,"Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Deductible C Only",null,null,null,"None","None","Yes","Deductible C Only",null,null,null,"None","None","Yes","Copayment Only",null,30,null,"None","None","Yes","Deductible C Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Rx Deductible+Co-pay",null,10,null,"None","None","Yes","Rx Deductible+Co-pay",null,30,null,"None","None","Yes","Not Covered",null,null,null,null,null,null,"No Cost Sharing",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Plan Deductible Only",null,null,null,"None","None","Yes","Not Covered",null,null,null,null,null,null,"Not Covered"]

{"sheet":"PLAN_OUTPUT_DATA","index":18,"n_rows":10,"n_cols":19,"rows_kept":10,"cut":false,"hidden":true,"merged":[]}
[]
[null,"This worksheet saves the results for the plans listed on the PLAN_OUTPUT_DATA worksheet."]
[null,"You can update the output by clicking on the button to the left."]
[null,"After the output data have been recalculated the RESULTS_SUMMARY worksheet will be displayed."]
[]
[null,"Maternity Example",null,null,null,null,null,"Diabetes Example",null,null,null,null,null,"Foot Fracture Example"]
["PLAN_ID","PLAN_PAYS","SUBSCRIBER_PAYS","SUBSCRIBER_DEDUC","SUBSCRIBER_COPAY","SUBSCRIBER_COINS","SUBSCRIBER_EXCL","PLAN_PAYS","SUBSCRIBER_PAYS","SUBSCRIBER_DEDUC","SUBSCRIBER_COPAY","SUBSCRIBER_COINS","SUBSCRIBER_EXCL","PLAN_PAYS","SUBSCRIBER_PAYS","SUBSCRIBER_DEDUC","SUBSCRIBER_COPAY","SUBSCRIBER_COINS","SUBSCRIBER_EXCL"]
["Plan 1",0,51038.13,0,0,0,51038.13,0,1631.33,0,0,0,7389.27,0,7389.27,0,0,0,1631.33]
["Plan 2",48959.98,2078.15,2018.14,0,0,60.02,6334.01,592.54999999999995,1000,0,0,55.26,1038.78,1055.26,592.54999999999995,0,0,0]
["Plan 3",48881.84,2163.39,2003.38,100,0,60.02,5564.54,460.18,1100,680,0,55.26,1171.1500000000001,1835.26,460.18,0,0,0]

{"sheet":"TimelineDocumentation","index":19,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":true,"merged":[]}
["For documentation related to this version of the coverage examples calculator see:"]
["sbc_tool_alt_20151001.xlsm"]