M.T.Donahoe & Associates, LLC

Area	flav	Metal	PN	Description	Product	CPID	SHOP	Click For	Start	End
DC	D	N/A	5201	BlueDental Basic (Std Fee)	DEN	5201	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5238	BlueDental Plus Plan 1 ORTHO (90 Fee)	DEN	5238	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5236	BlueDental Plus Plan 1 ORTHO (Std Fee)	DEN	5236	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5237	BlueDental Plus Plan 1 (90 Fee)	DEN	5237	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5235	BlueDental Plus Plan 1 (Std Fee)	DEN	5235	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5242	BlueDental Plus Plan 2 ORTHO (90 Fee)	DEN	5242	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5240	BlueDental Plus Plan 2 ORTHO (Std Fee)	DEN	5240	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5241	BlueDental Plus Plan 2 (90 Fee)	DEN	5241	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5239	BlueDental Plus Plan 2 (Std Fee)	DEN	5239	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5246	BlueDental Plus Plan 3 ORTHO (90 Fee)	DEN	5246	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5244	BlueDental Plus Plan 3 ORTHO (Std Fee)	DEN	5244	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5245	BlueDental Plus Plan 3 (90 Fee)	DEN	5245	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5243	BlueDental Plus Plan 3 (Std Fee)	DEN	5243	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5250	BlueDental Plus Plan 4 ORTHO (90 Fee)	DEN	5250	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5248	BlueDental Plus Plan 4 ORTHO (Std Fee)	DEN	5248	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5249	BlueDental Plus Plan 4 (90 Fee)	DEN	5249	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5247	BlueDental Plus Plan 4 (Std Fee)	DEN	5247	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5254	BlueDental Plus Plan 5 ORTHO (90 Fee)	DEN	5254	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5252	BlueDental Plus Plan 5 ORTHO (Std Fee)	DEN	5252	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5253	BlueDental Plus Plan 5 (90 Fee)	DEN	5253	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5251	BlueDental Plus Plan 5 (Std Fee)	DEN	5251	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5258	BlueDental Plus Plan 6 ORTHO (90 Fee)	DEN	5258	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5256	BlueDental Plus Plan 6 ORTHO (Std Fee)	DEN	5256	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5257	BlueDental Plus Plan 6 (90 Fee)	DEN	5257	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5255	BlueDental Plus Plan 6 (Std Fee)	DEN	5255	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5262	BlueDental Plus Plan 7 ORTHO (90 Fee)	DEN	5262	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5260	BlueDental Plus Plan 7 ORTHO (Std Fee)	DEN	5260	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5261	BlueDental Plus Plan 7 (90 Fee)	DEN	5261	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5259	BlueDental Plus Plan 7 (Std Fee)	DEN	5259	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5266	BlueDental Plus Plan 8 ORTHO (90 Fee)	DEN	5266	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5264	BlueDental Plus Plan 8 ORTHO (Std Fee)	DEN	5264	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5265	BlueDental Plus Plan 8 (90 Fee)	DEN	5265	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5263	BlueDental Plus Plan 8 (Std Fee)	DEN	5263	N/A	Benefits	7/1/2015	12/31/2021
DC	D	N/A	5420	Preferred Dental PPO Option 1	DEN	5420	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5421	Preferred Dental PPO Option 2	DEN	5421	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5422	Preferred Dental PPO Option 3	DEN	5422	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5423	Preferred Dental PPO Option 4	DEN	5423	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5424	Preferred Dental PPO Plan 1 ORTHO	DEN	5424	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5425	Preferred Dental PPO Plan 2 ORTHO	DEN	5425	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5426	Preferred Dental PPO Plan 3 ORTHO	DEN	5426	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5427	Preferred Dental PPO Plan 4 ORTHO	DEN	5427	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5433	Traditional Dental Plan 1	DEN	5433	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5428	Traditional Dental Plan 1 ORTHO	DEN	5428	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5434	Traditional Dental Plan 2	DEN	5434	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5429	Traditional Dental Plan 2 ORTHO	DEN	5429	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5435	Traditional Dental Plan 3	DEN	5435	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5430	Traditional Dental Plan 3 ORTHO	DEN	5430	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5431	Traditional Dental Plan 4	DEN	5431	N/A	Benefits	1/1/2017	12/31/2021
DC	D	N/A	5432	Traditional Dental Plan 4 ORTHO	DEN	5432	N/A	Benefits	1/1/2017	12/31/2021
DC	M	Bronze	27018	BLUECHOICE ADVANTAGE POS BRONZE $6,000 (HSA/HRA)	POS	100035907	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Bronze	27017	BLUECHOICE ADVANTAGE POS BRONZE $6,100 (HSA/HRA)	POS	100035889	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Bronze	27095	BLUECHOICE HMO 90 BRONZE $6,500 (HSA/HRA)	HMO	100035927	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Bronze	27092	BLUECHOICE HMO BRONZE $6,000 (HSA/HRA)	HMO	100035933	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Bronze	27094	BLUECHOICE HMO BRONZE $6,100 (HSA/HRA)	HMO	100035916	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Bronze	27055	BLUECHOICE HMO REFERRAL BRONZE $8,250 (HSA/HRA)	HMO	100035938	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Bronze	27177	BLUECHOICE PLUS POS BRONZE $6,100 (HSA/HRA)	POS	100035946	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27020	BLUECHOICE ADVANTAGE POS 90 GOLD $1,500 (HSA/HRA)	POS	100035901	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27046	BLUECHOICE ADVANTAGE POS GOLD $0 (Rx Ded $0)	POS	100035908	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27035	BLUECHOICE ADVANTAGE POS GOLD $1,000 (Rx Ded $250)	POS	100035883	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27021	BLUECHOICE ADVANTAGE POS GOLD $1,500 (HSA/HRA)	POS	100035893	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27036	BLUECHOICE ADVANTAGE POS GOLD $3,000 (Rx Ded $250)	POS	100035898	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27047	BLUECHOICE ADVANTAGE POS GOLD $500 (Rx Ded $250)	POS	100035884	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27098	BLUECHOICE HMO 90 GOLD $1,500 (HSA/HRA)	HMO	100035925	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27099	BLUECHOICE HMO GOLD $1,500 (HSA/HRA)	HMO	100035921	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27127	BLUECHOICE HMO GOLD $1,500 (Rx Ded $250)	HMO	100035909	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27128	BLUECHOICE HMO GOLD $3,000 (Rx Ded $250)	HMO	100035924	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27063	BLUECHOICE HMO GOLD $500 (Rx Ded $250)	HMO	100035910	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27115	BLUECHOICE HMO REFERRAL GOLD $0 (Rx Ded $0)	HMO	100035936	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27116	BLUECHOICE HMO REFERRAL GOLD $500 (Rx Ded $250)	HMO	100035935	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27183	BLUECHOICE PLUS POS GOLD $1,000 (Rx Ded $250)	POS	100035944	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27185	BLUECHOICE PLUS POS GOLD $500 (Rx Ded $250)	POS	100035945	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27144	BLUEPREFERRED PPO 90/70 GOLD $1,000 (HRA)	PPO	100035878	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27156	BLUEPREFERRED PPO GOLD $1,000 (Rx Ded $250)	PPO	100035868	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27157	BLUEPREFERRED PPO GOLD $1,500 (Rx Ded $250)	PPO	100035877	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Gold	27165	BLUEPREFERRED PPO GOLD $500 (Rx Ded $250)	PPO	100035869	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Platinum	27049	BLUECHOICE ADVANTAGE POS PLATINUM $0 (Rx Ded $0)	POS	100035885	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Platinum	27064	BLUECHOICE HMO PLATINUM $0 (Rx Ded $0)	HMO	100035911	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Platinum	27117	BLUECHOICE HMO REFERRAL PLATINUM $0 (Rx Ded $0)	HMO	100035934	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Platinum	27171	BLUECHOICE PLUS POS OPTOUT PLATINUM $0 (Rx Ded $0)	POS	100035950	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Platinum	27167	BLUEPREFERRED PPO PLATINUM $0 (Rx Ded $0)	PPO	100035874	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Platinum	27168	BLUEPREFERRED PPO PLATINUM $500 (Rx Ded $0)	PPO	100035875	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Platinum	27189	HEALTHYBLUE ADVANTAGE POS PLATINUM $500 (Rx Ded $0)	POS	100035888	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Platinum	27187	HEALTHYBLUE PLUS POS PLATINUM $500 (Rx Ded $0)	POS	100035943	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27025	BLUECHOICE ADVANTAGE POS 70 SILVER $2,100 (HSA/HRA)	POS	100035903	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27026	BLUECHOICE ADVANTAGE POS 70 SILVER $3,000 (HSA/HRA)	POS	100035905	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27022	BLUECHOICE ADVANTAGE POS SILVER $1,500 (HSA/HRA)	POS	100035886	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27023	BLUECHOICE ADVANTAGE POS SILVER $1,500 (HSA/HRA)	POS	100035896	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27024	BLUECHOICE ADVANTAGE POS SILVER $2,000 (HSA/HRA)	POS	100035899	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27027	BLUECHOICE ADVANTAGE POS SILVER $3,000 (HSA/HRA)	POS	100035891	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27037	BLUECHOICE ADVANTAGE POS SILVER $4,000 (Rx Ded $400)	POS	100035895	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27038	BLUECHOICE ADVANTAGE POS SILVER $5,000 (Rx Ded $450)	POS	100035897	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27103	BLUECHOICE HMO 70 SILVER $2,100 (HSA/HRA)	HMO	100035929	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27107	BLUECHOICE HMO 70 SILVER $3,000 (HSA/HRA)	HMO	100035931	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27058	BLUECHOICE HMO REFERRAL SILVER $4,000 (Rx Ded $400)	HMO	100035937	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27101	BLUECHOICE HMO SILVER $1,500 (HSA/HRA)	HMO	100035912	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27130	BLUECHOICE HMO SILVER $1,500 (Rx Ded $250)	HMO	100035920	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27102	BLUECHOICE HMO SILVER $2,000 (HSA/HRA)	HMO	100035914	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27108	BLUECHOICE HMO SILVER $3,000 (HSA/HRA)	HMO	100035918	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27131	BLUECHOICE HMO SILVER $5,000 (Rx Ded $450)	HMO	100035923	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27179	BLUECHOICE PLUS POS SILVER $1,500 (HSA/HRA)	POS	100035939	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27180	BLUECHOICE PLUS POS SILVER $2,500 (HSA/HRA)	POS	100035948	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27178	BLUECHOICE PLUS POS SILVER $3,000 (HSA/HRA)	POS	100035941	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27148	BLUEPREFERRED PPO 70 SILVER $2,100 (HSA/HRA)	PPO	100035881	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27150	BLUEPREFERRED PPO 80/60 SILVER $2,400 (HSA/HRA)	PPO	100035879	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27145	BLUEPREFERRED PPO SILVER $1,500 (HSA/HRA)	PPO	100035880	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27146	BLUEPREFERRED PPO SILVER $1,500 (HSA/HRA)	PPO	100035870	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27158	BLUEPREFERRED PPO SILVER $1,500 (Rx Ded $250)	PPO	100035876	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	M	Silver	27147	BLUEPREFERRED PPO SILVER $2,000 (HSA/HRA)	PPO	100035872	ON-SHOP	Benefits	1/1/2021	12/31/2021
DC	V	None	5625	BlueVision Plus Option 1 (FS/ER)	VIS	5625	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5627	BlueVision Plus Option 2 (FS/ER)	VIS	5627	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5629	BlueVision Plus Option 3 (FS/ER)	VIS	5629	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5631	BlueVision Plus Option 4 (FS/ER)	VIS	5631	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5633	BlueVision Plus Option A (FS/ER) Increased Allowances	VIS	5633	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5635	BlueVision Plus Option A (FS/VL) Increased Allowances	VIS	5635	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5637	BlueVision Plus Option B (FS/ER) Increased Allowances	VIS	5637	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5639	BlueVision Plus Option B (FS/VL) Increased Allowances	VIS	5639	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5641	BlueVision Plus Option C (FS/ER) Increased Allowances	VIS	5641	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5643	BlueVision Plus Option C (FS/VL) Increased Allowances	VIS	5643	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5645	BlueVision Plus Option D (FS/ER) Increased Allowances	VIS	5645	N/A	Benefits	1/1/2015	12/31/2021
DC	V	None	5647	BlueVision Plus Option D (FS/VL) Increased Allowances	VIS	5647	N/A	Benefits	1/1/2015	12/31/2021
MD	D	N/A	5200	BlueDental Basic (Std Fee)	DEN	5200	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5206	BlueDental Plus Plan 1 ORTHO (90 Fee)	DEN	5206	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5204	BlueDental Plus Plan 1 ORTHO (Std Fee)	DEN	5204	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5205	BlueDental Plus Plan 1 (90 Fee)	DEN	5205	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5203	BlueDental Plus Plan 1 (Std Fee)	DEN	5203	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5210	BlueDental Plus Plan 2 ORTHO (90 Fee)	DEN	5210	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5208	BlueDental Plus Plan 2 ORTHO (Std Fee)	DEN	5208	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5209	BlueDental Plus Plan 2 (90 Fee)	DEN	5209	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5207	BlueDental Plus Plan 2 (Std Fee)	DEN	5207	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5214	BlueDental Plus Plan 3 ORTHO (90 Fee)	DEN	5214	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5212	BlueDental Plus Plan 3 ORTHO (Std Fee)	DEN	5212	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5213	BlueDental Plus Plan 3 (90 Fee)	DEN	5213	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5211	BlueDental Plus Plan 3 (Std Fee)	DEN	5211	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5218	BlueDental Plus Plan 4 ORTHO (90 Fee)	DEN	5218	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5216	BlueDental Plus Plan 4 ORTHO (Std Fee)	DEN	5216	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5217	BlueDental Plus Plan 4 (90 Fee)	DEN	5217	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5215	BlueDental Plus Plan 4 (Std Fee)	DEN	5215	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5222	BlueDental Plus Plan 5 ORTHO (90 Fee)	DEN	5222	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5220	BlueDental Plus Plan 5 ORTHO (Std Fee)	DEN	5220	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5221	BlueDental Plus Plan 5 (90 Fee)	DEN	5221	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5219	BlueDental Plus Plan 5 (Std Fee)	DEN	5219	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5226	BlueDental Plus Plan 6 ORTHO (90 Fee)	DEN	5226	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5224	BlueDental Plus Plan 6 ORTHO (Std Fee)	DEN	5224	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5225	BlueDental Plus Plan 6 (90 Fee)	DEN	5225	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5223	BlueDental Plus Plan 6 (Std Fee)	DEN	5223	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5230	BlueDental Plus Plan 7 ORTHO (90 Fee)	DEN	5230	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5228	BlueDental Plus Plan 7 ORTHO (Std Fee)	DEN	5228	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5229	BlueDental Plus Plan 7 (90 Fee)	DEN	5229	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5227	BlueDental Plus Plan 7 (Std Fee)	DEN	5227	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5234	BlueDental Plus Plan 8 ORTHO (90 Fee)	DEN	5234	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5232	BlueDental Plus Plan 8 ORTHO (Std Fee)	DEN	5232	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5233	BlueDental Plus Plan 8 (90 Fee)	DEN	5233	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5231	BlueDental Plus Plan 8 (Std Fee)	DEN	5231	N/A	Benefits	7/1/2015	12/31/2021
MD	D	N/A	5404	Preferred Dental PPO Plan 1	DEN	5404	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5408	Preferred Dental PPO Plan 1 ORTHO	DEN	5408	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5405	Preferred Dental PPO Plan 2	DEN	5405	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5409	Preferred Dental PPO Plan 2 ORTHO	DEN	5409	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5406	Preferred Dental PPO Plan 3	DEN	5406	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5410	Preferred Dental PPO Plan 3 ORTHO	DEN	5410	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5407	Preferred Dental PPO Plan 4	DEN	5407	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5411	Preferred Dental PPO Plan 4 ORTHO	DEN	5411	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5417	Traditional Dental Plan 1	DEN	5417	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5412	Traditional Dental Plan 1 ORTHO	DEN	5412	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5418	Traditional Dental Plan 2	DEN	5418	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5413	Traditional Dental Plan 2 ORTHO	DEN	5413	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5419	Traditional Dental Plan 3	DEN	5419	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5414	Traditional Dental Plan 3 ORTHO	DEN	5414	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5415	Traditional Dental Plan 4	DEN	5415	N/A	Benefits	1/1/2017	12/31/2021
MD	D	N/A	5416	Traditional Dental Plan 4 ORTHO	DEN	5416	N/A	Benefits	1/1/2017	12/31/2021
MD	M	Bronze	27001	BLUECHOICE ADVANTAGE POS BRONZE $6,000	POS	100035634	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27016	BLUECHOICE ADVANTAGE POS BRONZE $6,100 (HSA/HRA)	POS	100035510	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27193	BLUECHOICE ADVANTAGE POS BRONZE $6,100 (HSA/HRA)	POS	100035519	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27070	BLUECHOICE HMO 90 BRONZE $6,500 (HSA/HRA)	HMO	100035654	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27091	BLUECHOICE HMO BRONZE $6,000	HMO	100035709	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27066	BLUECHOICE HMO BRONZE $6,000 (HRA)	HMO	100035707	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27068	BLUECHOICE HMO BRONZE $6,100 (HSA/HRA)	HMO	100035652	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27093	BLUECHOICE HMO BRONZE $6,100 (HSA/HRA)	HMO	100035648	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27050	BLUECHOICE HMO REFERRAL BRONZE $6,200 (HSA/HRA)	HMO	100035639	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27053	BLUECHOICE HMO REFERRAL BRONZE $6,200 (HSA/HRA)	HMO	100035637	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27054	BLUECHOICE HMO REFERRAL BRONZE $8,250	HMO	100035713	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27052	BLUECHOICE HMO REFERRAL BRONZE $8,250 (HRA)	HMO	100035715	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27173	BLUECHOICE PLUS POS BRONZE $6,100 (HSA/HRA)	POS	100035732	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27207	BLUEPREFERRED PPO BRONZE $6,200 (HSA/HRA)	PPO	100035825	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Bronze	27132	BLUEPREFERRED PPO BRONZE $6,200 (HSA/HRA)	PPO	100035787	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27003	BLUECHOICE ADVANTAGE POS 90 GOLD $1,500 (HSA/HRA)	POS	100035587	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27040	BLUECHOICE ADVANTAGE POS GOLD $0 (Rx Ded $0)	POS	100035630	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27034	BLUECHOICE ADVANTAGE POS GOLD $1,000 (Rx Ded $250)	POS	100035576	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27029	BLUECHOICE ADVANTAGE POS GOLD $1,000 (Rx Ded $250)	POS	100035578	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27019	BLUECHOICE ADVANTAGE POS GOLD $1,500 (HSA/HRA)	POS	100035544	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27196	BLUECHOICE ADVANTAGE POS GOLD $1,500 (HSA/HRA)	POS	100035551	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27194	BLUECHOICE ADVANTAGE POS GOLD $3,000 (Rx Ded $250)	POS	100035573	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27042	BLUECHOICE ADVANTAGE POS GOLD $500 (Rx Ded $250)	POS	100035593	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27075	BLUECHOICE HMO 90 GOLD $1,500 (HSA/HRA)	HMO	100035693	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27097	BLUECHOICE HMO GOLD $1,000	HMO	100035699	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27072	BLUECHOICE HMO GOLD $1,000 (HRA)	HMO	100035696	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27077	BLUECHOICE HMO GOLD $1,500 (HSA/HRA)	HMO	100035689	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27126	BLUECHOICE HMO GOLD $1,500 (Rx Ded $250)	HMO	100035723	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27119	BLUECHOICE HMO GOLD $1,500 (Rx Ded $250)	HMO	100035724	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27120	BLUECHOICE HMO GOLD $3,000 (Rx Ded $250)	HMO	100035721	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27060	BLUECHOICE HMO GOLD $500 (Rx Ded $250)	HMO	100035646	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27110	BLUECHOICE HMO REFERRAL GOLD $0 (Rx Ded $0)	HMO	100035710	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27112	BLUECHOICE HMO REFERRAL GOLD $500 (Rx Ded $250)	HMO	100035711	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27182	BLUECHOICE PLUS POS GOLD $1,000 (Rx Ded $250)	POS	100035774	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27197	BLUECHOICE PLUS POS GOLD $500 (Rx Ded $250)	POS	100035778	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27204	BLUEPREFERRED PPO 90/70 GOLD $1,000	PPO	100035852	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27206	BLUEPREFERRED PPO 90/70 GOLD $1,000 (HRA)	PPO	100035853	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27201	BLUEPREFERRED PPO GOLD $1,000 (Rx Ded $250)	PPO	100035860	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27153	BLUEPREFERRED PPO GOLD $1,500 (Rx Ded $250)	PPO	100035821	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Gold	27160	BLUEPREFERRED PPO GOLD $500 (Rx Ded $250)	PPO	100035822	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Platinum	27190	BLUECHOICE ADVANTAGE POS PLATINUM $0 (Rx Ded $0)	POS	100035596	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Platinum	27062	BLUECHOICE HMO PLATINUM $0 (Rx Ded $0)	HMO	100035647	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Platinum	27114	BLUECHOICE HMO REFERRAL PLATINUM $0 (Rx Ded $0)	HMO	100035712	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Platinum	27170	BLUECHOICE PLUS POS OPTOUT PLATINUM $0 (Rx Ded $0)	POS	100035731	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Platinum	27202	BLUEPREFERRED PPO PLATINUM $0 (Rx Ded $0)	PPO	100035866	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Platinum	27203	BLUEPREFERRED PPO PLATINUM $500 (Rx Ded $0)	PPO	100035867	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Platinum	27209	HEALTHYBLUE ADVANTAGE POS PLATINUM $500 (Rx Ded $0)	POS	100035628	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Platinum	27210	HEALTHYBLUE PLUS POS PLATINUM $500 (Rx Ded $0)	POS	100035781	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27011	BLUECHOICE ADVANTAGE POS 70 SILVER $2,100 (HSA/HRA)	POS	100035619	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27013	BLUECHOICE ADVANTAGE POS 70 SILVER $3,000 (HSA/HRA)	POS	100035599	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27006	BLUECHOICE ADVANTAGE POS SILVER $1,500 (HSA/HRA)	POS	100035535	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27008	BLUECHOICE ADVANTAGE POS SILVER $2,000 (HSA/HRA)	POS	100035610	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27015	BLUECHOICE ADVANTAGE POS SILVER $3,000 (HSA/HRA)	POS	100035526	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27191	BLUECHOICE ADVANTAGE POS SILVER $3,000 (HSA/HRA)	POS	100035521	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27195	BLUECHOICE ADVANTAGE POS SILVER $4,000 (Rx Ded $400)	POS	100035567	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27192	BLUECHOICE ADVANTAGE POS SILVER $5,000 (Rx Ded $450)	POS	100035555	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27032	BLUECHOICE ADVANTAGE POS SILVER $5,000 (Rx Ded $450)	POS	100035557	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27083	BLUECHOICE HMO 70 SILVER $2,100 (HSA/HRA)	HMO	100035675	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27088	BLUECHOICE HMO 70 SILVER $3,000 (HSA/HRA)	HMO	100035668	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27057	BLUECHOICE HMO REFERRAL SILVER $4,000 (Rx Ded $400)	HMO	100035644	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27079	BLUECHOICE HMO SILVER $1,500 (HSA/HRA)	HMO	100035701	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27100	BLUECHOICE HMO SILVER $1,500 (HSA/HRA)	HMO	100035700	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27124	BLUECHOICE HMO SILVER $1,500 (Rx Ded $250)	HMO	100035718	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27081	BLUECHOICE HMO SILVER $2,000 (HSA/HRA)	HMO	100035674	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27085	BLUECHOICE HMO SILVER $2,400 (HSA/HRA)	HMO	100035681	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27105	BLUECHOICE HMO SILVER $2,400 (HSA/HRA)	HMO	100035685	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27106	BLUECHOICE HMO SILVER $3,000 (HSA/HRA)	HMO	100035659	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27090	BLUECHOICE HMO SILVER $3,000 (HSA/HRA)	HMO	100035662	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27122	BLUECHOICE HMO SILVER $5,000 (Rx Ded $450)	HMO	100035729	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27129	BLUECHOICE HMO SILVER $5,000 (Rx Ded $450)	HMO	100035727	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27200	BLUECHOICE PLUS POS SILVER $1,500 (HSA/HRA)	POS	100035759	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27198	BLUECHOICE PLUS POS SILVER $2,500 (HSA/HRA)	POS	100035770	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27199	BLUECHOICE PLUS POS SILVER $3,000 (HSA/HRA)	POS	100035747	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27139	BLUEPREFERRED PPO 70 SILVER $2,100 (HSA/HRA)	PPO	100035804	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27141	BLUEPREFERRED PPO 80/60 SILVER $2,400 (HSA/HRA)	PPO	100035795	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27208	BLUEPREFERRED PPO 80/60 SILVER $2,400 (HSA/HRA)	PPO	100035836	ON-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27136	BLUEPREFERRED PPO SILVER $1,500 (HSA/HRA)	PPO	100035789	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27155	BLUEPREFERRED PPO SILVER $1,500 (Rx Ded $250)	PPO	100035815	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	M	Silver	27205	BLUEPREFERRED PPO SILVER $2,000 (HSA/HRA)	PPO	100035845	OFF-SHOP	Benefits	1/1/2021	12/31/2021
MD	V	None	5601	BlueVision Plus Option 1 (FS/ER)	VIS	5601	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5603	BlueVision Plus Option 2 (FS/ER)	VIS	5603	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5605	BlueVision Plus Option 3 (FS/ER)	VIS	5605	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5607	BlueVision Plus Option 4 (FS/ER)	VIS	5607	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5609	BlueVision Plus Option A (FS/ER) Increased Allowances	VIS	5609	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5611	BlueVision Plus Option A (FS/VL) Increased Allowances	VIS	5611	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5613	BlueVision Plus Option B (FS/ER) Increased Allowances	VIS	5613	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5615	BlueVision Plus Option B (FS/VL) Increased Allowances	VIS	5615	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5617	BlueVision Plus Option C (FS/ER) Increased Allowances	VIS	5617	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5619	BlueVision Plus Option C (FS/VL) Increased Allowances	VIS	5619	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5621	BlueVision Plus Option D (FS/ER) Increased Allowances	VIS	5621	N/A	Benefits	1/1/2015	12/31/2021
MD	V	None	5623	BlueVision Plus Option D (FS/VL) Increased Allowances	VIS	5623	N/A	Benefits	1/1/2015	12/31/2021
VA	D	N/A	5202	BlueDental Basic (Std Fee)	DEN	5202	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5270	BlueDental Plus Plan 1 ORTHO (90 Fee)	DEN	5270	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5268	BlueDental Plus Plan 1 ORTHO (Std Fee)	DEN	5268	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5269	BlueDental Plus Plan 1 (90 Fee)	DEN	5269	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5267	BlueDental Plus Plan 1 (Std Fee)	DEN	5267	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5274	BlueDental Plus Plan 2 ORTHO (90 Fee)	DEN	5274	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5272	BlueDental Plus Plan 2 ORTHO (Std Fee)	DEN	5272	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5273	BlueDental Plus Plan 2 (90 Fee)	DEN	5273	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5271	BlueDental Plus Plan 2 (Std Fee)	DEN	5271	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5278	BlueDental Plus Plan 3 ORTHO (90 Fee)	DEN	5278	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5276	BlueDental Plus Plan 3 ORTHO (Std Fee)	DEN	5276	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5277	BlueDental Plus Plan 3 (90 Fee)	DEN	5277	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5275	BlueDental Plus Plan 3 (Std Fee)	DEN	5275	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5282	BlueDental Plus Plan 4 ORTHO (90 Fee)	DEN	5282	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5280	BlueDental Plus Plan 4 ORTHO (Std Fee)	DEN	5280	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5281	BlueDental Plus Plan 4 (90 Fee)	DEN	5281	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5279	BlueDental Plus Plan 4 (Std Fee)	DEN	5279	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5286	BlueDental Plus Plan 5 ORTHO (90 Fee)	DEN	5286	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5284	BlueDental Plus Plan 5 ORTHO (Std Fee)	DEN	5284	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5285	BlueDental Plus Plan 5 (90 Fee)	DEN	5285	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5283	BlueDental Plus Plan 5 (Std Fee)	DEN	5283	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5290	BlueDental Plus Plan 6 ORTHO (90 Fee)	DEN	5290	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5288	BlueDental Plus Plan 6 ORTHO (Std Fee)	DEN	5288	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5289	BlueDental Plus Plan 6 (90 Fee)	DEN	5289	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5287	BlueDental Plus Plan 6 (Std Fee)	DEN	5287	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5294	BlueDental Plus Plan 7 ORTHO (90 Fee)	DEN	5294	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5292	BlueDental Plus Plan 7 ORTHO (Std Fee)	DEN	5292	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5293	BlueDental Plus Plan 7 (90 Fee)	DEN	5293	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5291	BlueDental Plus Plan 7 (Std Fee)	DEN	5291	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5298	BlueDental Plus Plan 8 ORTHO (90 Fee)	DEN	5298	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5296	BlueDental Plus Plan 8 ORTHO (Std Fee)	DEN	5296	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5297	BlueDental Plus Plan 8 (90 Fee)	DEN	5297	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5295	BlueDental Plus Plan 8 (Std Fee)	DEN	5295	N/A	Benefits	7/1/2015	12/31/2021
VA	D	N/A	5436	Preferred Dental PPO Plan 1	DEN	5436	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5440	Preferred Dental PPO Plan 1 ORTHO	DEN	5440	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5437	Preferred Dental PPO Plan 2	DEN	5437	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5441	Preferred Dental PPO Plan 2 ORTHO	DEN	5441	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5438	Preferred Dental PPO Plan 3	DEN	5438	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5442	Preferred Dental PPO Plan 3 ORTHO	DEN	5442	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5439	Preferred Dental PPO Plan 4	DEN	5439	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5443	Preferred Dental PPO Plan 4 ORTHO	DEN	5443	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5448	Traditional Dental Plan 1	DEN	5448	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5444	Traditional Dental Plan 1 ORTHO	DEN	5444	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5449	Traditional Dental Plan 2	DEN	5449	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5445	Traditional Dental Plan 2 ORTHO	DEN	5445	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5450	Traditional Dental Plan 3	DEN	5450	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5446	Traditional Dental Plan 3 ORTHO	DEN	5446	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5451	Traditional Dental Plan 4	DEN	5451	N/A	Benefits	1/1/2017	12/31/2021
VA	D	N/A	5447	Traditional Dental Plan 4 ORTHO	DEN	5447	N/A	Benefits	1/1/2017	12/31/2021
VA	M	Bronze	27000	BLUECHOICE ADVANTAGE POS BRONZE $6,000 (HRA)	POS	100035423	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Bronze	27002	BLUECHOICE ADVANTAGE POS BRONZE $6,100 (HSA/HRA)	POS	100035152	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Bronze	27069	BLUECHOICE HMO 90 BRONZE $6,500 (HSA/HRA)	HMO	100035234	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Bronze	27065	BLUECHOICE HMO BRONZE $6,000 (HRA)	HMO	100035425	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Bronze	27067	BLUECHOICE HMO BRONZE $6,100 (HSA/HRA)	HMO	100035232	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Bronze	27051	BLUECHOICE HMO REFERRAL BRONZE $8,250 (HRA)	HMO	100035284	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Bronze	27172	BLUECHOICE PLUS POS BRONZE $6,100 (HSA/HRA)	POS	100035297	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27004	BLUECHOICE ADVANTAGE POS 90 GOLD $1,500 (HSA/HRA)	POS	100035163	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27039	BLUECHOICE ADVANTAGE POS GOLD $0 (Rx Ded $0)	POS	100035208	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27028	BLUECHOICE ADVANTAGE POS GOLD $1,000 (Rx Ded $250)	POS	100035195	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27005	BLUECHOICE ADVANTAGE POS GOLD $1,500 (HSA/HRA)	POS	100035160	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27030	BLUECHOICE ADVANTAGE POS GOLD $3,000 (Rx Ded $250)	POS	100035199	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27041	BLUECHOICE ADVANTAGE POS GOLD $500 (Rx Ded $250)	POS	100035200	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27074	BLUECHOICE HMO 90 GOLD $1,500 (HSA/HRA)	HMO	100035245	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27096	BLUECHOICE HMO GOLD $1,000	HMO	100035216	ON-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27071	BLUECHOICE HMO GOLD $1,000 (HRA)	HMO	100035218	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27073	BLUECHOICE HMO GOLD $1,000 SE	HMO	100035220	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27076	BLUECHOICE HMO GOLD $1,500 (HSA/HRA)	HMO	100035238	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27118	BLUECHOICE HMO GOLD $1,500 (Rx Ded $250)	HMO	100035274	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27121	BLUECHOICE HMO GOLD $3,000 (Rx Ded $250)	HMO	100035276	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27059	BLUECHOICE HMO GOLD $500 (Rx Ded $250)	HMO	100035279	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27109	BLUECHOICE HMO REFERRAL GOLD $0 (Rx Ded $0)	HMO	100035289	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27111	BLUECHOICE HMO REFERRAL GOLD $500 (Rx Ded $250)	HMO	100035285	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27181	BLUECHOICE PLUS POS GOLD $1,000 (Rx Ded $250)	POS	100035319	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27184	BLUECHOICE PLUS POS GOLD $500 (Rx Ded $250)	POS	100035369	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27143	BLUEPREFERRED PPO 90/70 GOLD $1,000	PPO	100035321	ON-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27133	BLUEPREFERRED PPO 90/70 GOLD $1,000 (HRA)	PPO	100035323	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27134	BLUEPREFERRED PPO 90/70 GOLD $1,000 SE (HRA)	PPO	100035327	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27151	BLUEPREFERRED PPO GOLD $1,000 (Rx Ded $250)	PPO	100035357	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27152	BLUEPREFERRED PPO GOLD $1,500 (Rx Ded $250)	PPO	100035361	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Gold	27159	BLUEPREFERRED PPO GOLD $500 (Rx Ded $250)	PPO	100035363	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27043	BLUECHOICE ADVANTAGE POS 90/70 PLATINUM $0 (Rx Ded $0)	POS	100035192	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27048	BLUECHOICE ADVANTAGE POS 90/70 PLATINUM $0 (Rx Ded $0)	POS	100035191	ON-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27045	BLUECHOICE ADVANTAGE POS 90/70 PLATINUM SE $0 (Rx Ded $0)	POS	100035193	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27044	BLUECHOICE ADVANTAGE POS PLATINUM $0 (Rx Ded $0)	POS	100035201	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27061	BLUECHOICE HMO PLATINUM $0 (Rx Ded $0)	HMO	100035280	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27113	BLUECHOICE HMO REFERRAL PLATINUM $0 (Rx Ded $0)	HMO	100035290	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27169	BLUECHOICE PLUS POS OPTOUT PLATINUM $0 (Rx Ded $0)	POS	100035320	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27166	BLUEPREFERRED PPO 100/80 PLATINUM $0 (Rx Ded $0)	PPO	100035339	ON-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27161	BLUEPREFERRED PPO 100/80 PLATINUM $0 (Rx Ded $0)	PPO	100035340	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27164	BLUEPREFERRED PPO 100/80 PLATINUM SE $0 (Rx Ded $0)	PPO	100035341	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27162	BLUEPREFERRED PPO PLATINUM $0 (Rx Ded $0)	PPO	100035364	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27163	BLUEPREFERRED PPO PLATINUM $500 (Rx Ded $0)	PPO	100035365	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27188	HEALTHYBLUE ADVANTAGE POS PLATINUM $500 (Rx Ded $0)	POS	100035367	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Platinum	27186	HEALTHYBLUE PLUS POS PLATINUM $500 (Rx Ded $0)	POS	100035368	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27010	BLUECHOICE ADVANTAGE POS 70 SILVER $2,100 (HSA/HRA)	POS	100035176	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27012	BLUECHOICE ADVANTAGE POS 70 SILVER $3,000 (HSA/HRA)	POS	100035187	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27007	BLUECHOICE ADVANTAGE POS SILVER $1,500 (HSA/HRA)	POS	100035166	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27009	BLUECHOICE ADVANTAGE POS SILVER $2,000 (HSA/HRA)	POS	100035171	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27014	BLUECHOICE ADVANTAGE POS SILVER $3,000 (HSA/HRA)	POS	100035184	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27031	BLUECHOICE ADVANTAGE POS SILVER $4,000 (Rx Ded $400)	POS	100035203	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27033	BLUECHOICE ADVANTAGE POS SILVER $5,000 (Rx Ded $450)	POS	100035205	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27082	BLUECHOICE HMO 70 SILVER $2,100 (HSA/HRA)	HMO	100035260	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27087	BLUECHOICE HMO 70 SILVER $3,000 (HSA/HRA)	HMO	100035268	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27056	BLUECHOICE HMO REFERRAL SILVER $4,000 (Rx Ded $400)	HMO	100035288	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27078	BLUECHOICE HMO SILVER $1,500 (HSA/HRA)	HMO	100035252	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27123	BLUECHOICE HMO SILVER $1,500 (Rx Ded $250)	HMO	100035291	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27080	BLUECHOICE HMO SILVER $2,000 (HSA/HRA)	HMO	100035257	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27084	BLUECHOICE HMO SILVER $2,400 (HSA/HRA)	HMO	100035214	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27104	BLUECHOICE HMO SILVER $2,400 (HSA/HRA)	HMO	100035210	ON-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27086	BLUECHOICE HMO SILVER $2,400 SE (HSA/HRA)	HMO	100035225	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27089	BLUECHOICE HMO SILVER $3,000 (HSA/HRA)	HMO	100035265	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27125	BLUECHOICE HMO SILVER $5,000 (Rx Ded $450)	HMO	100035295	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27174	BLUECHOICE PLUS POS SILVER $1,500 (HSA/HRA)	POS	100035303	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27175	BLUECHOICE PLUS POS SILVER $2,500 (HSA/HRA)	POS	100035309	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27176	BLUECHOICE PLUS POS SILVER $3,000 (HSA/HRA)	POS	100035312	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27138	BLUEPREFERRED PPO 70 SILVER $2,100 (HSA/HRA)	PPO	100035353	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27140	BLUEPREFERRED PPO 80/60 SILVER $2,400 (HSA/HRA)	PPO	100035331	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27149	BLUEPREFERRED PPO 80/60 SILVER $2,400 (HSA/HRA)	PPO	100035328	ON-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27142	BLUEPREFERRED PPO 80/60 SILVER $2,400 SE (HSA/HRA)	PPO	100035336	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27135	BLUEPREFERRED PPO SILVER $1,500 (HSA/HRA)	PPO	100035346	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27154	BLUEPREFERRED PPO SILVER $1,500 (Rx Ded $250)	PPO	100035366	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	M	Silver	27137	BLUEPREFERRED PPO SILVER $2,000 (HSA/HRA)	PPO	100035347	OFF-SHOP	Benefits	1/1/2021	12/31/2021
VA	V	None	5649	BlueVision Plus Option 1 (FS/ER)	VIS	5649	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5651	BlueVision Plus Option 2 (FS/ER)	VIS	5651	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5653	BlueVision Plus Option 3 (FS/ER)	VIS	5653	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5655	BlueVision Plus Option 4 (FS/ER)	VIS	5655	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5657	BlueVision Plus Option A (FS/ER) Increased Allowances	VIS	5657	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5659	BlueVision Plus Option A (FS/VL) Increased Allowances	VIS	5659	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5661	BlueVision Plus Option B (FS/ER) Increased Allowances	VIS	5661	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5663	BlueVision Plus Option B (FS/VL) Increased Allowances	VIS	5663	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5665	BlueVision Plus Option C (FS/ER) Increased Allowances	VIS	5665	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5667	BlueVision Plus Option C (FS/VL) Increased Allowances	VIS	5667	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5669	BlueVision Plus Option D (FS/ER) Increased Allowances	VIS	5669	N/A	Benefits	1/1/2015	12/31/2021
VA	V	None	5671	BlueVision Plus Option D (FS/VL) Increased Allowances	VIS	5671	N/A	Benefits	1/1/2015	12/31/2021
DC	D	N/A	5335	BlueDental EPO	DEN	5335	N/A	Benefits	6/1/2019	7/31/2021
DC	D	N/A	5336	BlueDental EPO w/Ortho	DEN	5336	N/A	Benefits	6/1/2019	7/31/2021
MD	D	N/A	5333	BlueDental EPO	DEN	5333	N/A	Benefits	6/1/2019	7/31/2021
MD	D	N/A	5334	BlueDental EPO w/Ortho	DEN	5334	N/A	Benefits	6/1/2019	7/31/2021
VA	D	N/A	5337	BlueDental EPO	DEN	5337	N/A	Benefits	6/1/2019	7/31/2021
VA	D	N/A	5338	BlueDental EPO w/Ortho	DEN	5338	N/A	Benefits	6/1/2019	7/31/2021

Word in Desc	Replaced with
ANTHEM
AETNA
EVERGREEN
KP
HEALTHKEEPERS	HK
BLUEPREFERRED	BP
BLUECHOICE PLUS	BCP
BLUECHOICE	BCH
HEALTHYBLUE	HB
ADVANTAGE	Adv
BLUEFUND	BF
COMPATIBLE	Comp

State	Metal	Product	Shop