{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["Choose SIC and Region","CoPower ONE DHMO","CoPower ONE DPPO","CoPower ONE Non-MPB Dual Choice","CoPower ONE MPB Dual Choice","Lists"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":83,"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":"Choose SIC and Region","index":0,"n_rows":54,"n_cols":6,"rows_kept":54,"cut":false,"hidden":false,"merged":[[4,0,4,2],[5,0,5,2],[7,0,7,1],[52,0,52,5],[53,0,54,5],[0,1,0,5],[17,0,17,1],[16,0,16,1],[15,3,15,4],[2,0,2,2],[18,0,18,1],[2,3,2,5],[3,0,3,2],[11,0,11,2],[16,3,16,4],[17,3,17,4],[1,0,1,2],[18,3,18,4],[14,3,14,4],[1,3,1,5],[13,3,13,4],[3,3,3,5],[13,0,13,1],[14,0,14,1],[42,6,42,10],[43,6,43,10],[36,6,36,10],[14,6,14,10],[32,0,32,5],[29,0,29,1],[39,0,39,1],[33,3,33,4],[21,0,21,1],[28,0,28,1],[27,0,27,1],[26,3,26,4],[42,0,42,1],[36,0,36,1],[40,3,40,4],[30,3,30,4],[31,3,31,4],[37,3,37,4],[36,3,36,4],[35,0,35,1],[30,0,30,1],[22,0,22,1],[39,3,39,4],[27,3,27,4],[43,3,43,4],[34,3,34,4],[34,0,34,1],[15,0,15,1],[19,3,19,4],[38,3,38,4],[20,0,20,1],[33,0,33,1],[19,0,19,1],[23,3,23,4],[24,3,24,4],[22,3,22,4],[25,3,25,4],[12,0,12,5],[11,3,11,5],[34,6,34,10],[35,6,35,10],[15,6,15,10],[16,6,16,10],[18,6,18,10],[19,6,19,10],[20,6,20,10],[21,6,21,10],[33,6,33,10],[29,3,29,4],[21,3,21,4],[28,3,28,4],[20,3,20,4],[35,3,35,4],[31,0,31,1],[13,6,13,10],[45,6,45,10],[46,0,46,1],[37,0,37,1],[46,3,46,4],[41,0,41,5],[50,0,50,5],[49,0,49,5],[38,0,38,1],[23,0,23,1],[48,3,48,4],[47,0,47,1],[48,0,48,1],[47,3,47,4],[42,3,42,4],[40,0,40,1],[24,0,24,1],[45,3,45,4],[45,0,45,1],[44,0,44,1],[44,3,44,4],[44,6,44,10],[26,0,26,1],[25,0,25,1],[43,0,43,1]]}
[null,"New York CoPower ONE \nRate Areas and SIC Codes"]
["NY DPPO Rate Area Definitions"]
["Region 1",null,null,"Region 2"]
["ZIP Codes 100 - 102",null,null,"ZIP Codes: 103-119, 124 (Orange), 125 (Orange, Putnam), 127 (Orange)"]
["Region 3"]
["Zip Codes: 120-123, 124 (Ulster), 125 (Ulster), 126, 127 (Delaware, Sullivan, Ulster),\n128-149"]
[]
["NY DHMO Rate Area Definitions"]
["Region 1","Region 2"]
["Zip Codes: 100-102","Zip Codes: 103-149"]
[]
["SIC Level Classifications"]
["Level 1 Eligible Industries - Delta Dental (DPPO)"]
["Advertising (except Misc., not classified 7319)",null,"7311-7313","Hospitals",null,"8062-8069"]
["Agriculture, Forestry, Fishing \n(except seasonal employees)",null,"0100-0999","Independent Auto Repair and Services",null,"7532-7599"]
["Auto Rental Agencies",null,"7513-7519","Laundry/Garment Service/Show Repair Services",null,"7211-7219, \n7251"]
["Automobile Parking Services",null,7521,"Manufacturing (except Jewelry Manufacturing)",null,"2000-2699"]
["Building Maintenance / Equipment Rental",null,"7349-7359","Manufacturing (Chemicals, Allied and Other)",null,"2810-3999"]
["Collection Agencies and Credit Reporting Services",null,"7322-7323","Mining, Oil and Gas Extraction",null,"1000-1499"]
["Communication \n(Radio, Telephone, TV/Radio Broadcasting)",null,"4800-4899","Miscellaneous Repair \n(Welding, etc)",null,"7692-7699"]
["Community Services Organizations / Social Services",null,"8300-8499","Museum Art Galleries and Gardens",null,"8412, 8422"]
["Computer Programming and Other Computer Services",null,"7371-7379","New Syndicates",null,7383]
["Construction Contractors",null,"1500-1799","Photofinishing Labs",null,7384]
["Direct Mailing, Reproduction, Secretarial Services",null,"7331-7338","Printing and Publishing",null,"2700-2799"]
["Disinfecting and Pest Control Services",null,7342,"Public Administration \n(Cities, Counties, Police, etc)",null,"9000-9720, \n9722-9998"]
["Government Funded Groups   ",null,"8300-8499","Public and Private Schools \n(Elementary and High School)",null,"8200-8299"]
["Electrical Repair \n(Radio, TV, A/C, Refrigerator)",null,"7622-7629","Retail",null,"5200-5510, \n5610-5699, \n5712-5736, \n5912-5999"]
["Engineering and Management Services",null,"8711-8748","Security Systems, Detectives, Armored Car",null,"7381-7382"]
["Finance (Banks, Securities, Credit Agencies)",null,"6000-6299","Transportation",null,"4000-4799"]
["Funeral Services and Crematories",null,7261,"Utilities",null,"4900-4999"]
["Furniture Repair/Reupholstery",null,7641,"Wholesale Trade",null,"5000-5199"]
["Misc. Computer Services          ",null,7379]
["Level 2 Eligible Industries - Delta Dental (DPPO)"]
["Advertising (Miscellaneous, not classified)",null,7319,"Medical Groups",null,"8000-8059,\n8082-8099"]
["Automobile Dealerships",null,"5511-5599","Photographic Studios",null,7221]
["Amusement, Recreation, and Entertainment",null,"7800-7999","Restaurants",null,"5088-5899"]
["Hotels",null,"7000-7099","Tax Return Preparation Services /\nMisc. Personal Svcs",null,"7291-7299"]
["Insurance Carriers/Brokers",null,"6300-6499","Real Estate",null,"6500-6799"]
["Jewelry Manufacturing",null,"3911-3915","Religious Organizations (Admin. And Mgmt. staff only)",null,8661]
["Legal",null,"8100-8199","Watch, Clock and Jewelry Repair",null,7631]
["Management Carve-out (any industry)  ",null,9999]
["Ineligible Industries - Delta Dental (DPPO)"]
["Associations and Trusts1",null,"8600-8660, \n8662-8699","Religious Organizations \n(except Churches #8661)   ",null,"No SIC"]
["Beauty and Barber Shops",null,"7231-7241","Private Households",null,8811]
["International Affairs",null,9721,"Partnerships",null,"No SIC"]
["Dental Offices, Dental Labs, and Medical Labs",null,"8021, 8071, 8072","Seasonal Employees (Christmas/Part-time Help)",null,"No SIC"]
["Employment Agencies & PEOs",null,"7361-7363","Seasonal Employees (Agriculture)",null,"0761-0783"]
["Groups with high turnover2",null,"Varies","Miscellaneous Services not classified elsewhere",null,8999]
["Miscellaneous Business Services",null,7389,"Cannabis or Cannabis Related Industries",null,"No SIC"]
["1  Management and administrative staff of associations and trusts are eligible at Level 2.  Use SIC Code 9999."]
["2 A business has high turnover if 20% or more of the average number of its employees during the past 12 months were newly hired for reasons other than the growth of the business."]
[]
["Ineligible Industries - DeltaCare® USA (DHMO)"]
["Law firms, associations, groups with seasonal employment, groups without an employee/employer relationship and businesses with high turnover2 are not eligible for any DeltaCare® USA plan. All groups in the cannabis or cannabis related industries are ineligible."]

{"sheet":"CoPower ONE DHMO","index":1,"n_rows":61,"n_cols":12,"rows_kept":61,"cut":false,"hidden":false,"merged":[[12,3,12,4],[13,3,13,4],[55,0,55,7],[56,0,56,7],[59,0,59,7],[9,1,9,2],[12,8,15,8],[4,8,6,8],[9,8,11,8],[11,3,11,4],[19,6,19,7],[17,9,19,9],[18,0,18,1],[18,6,18,7],[19,0,19,1],[19,2,19,3],[17,2,17,3],[17,4,17,5],[17,6,17,7],[19,4,19,5],[18,4,18,5],[18,2,18,3],[6,3,6,7],[6,0,6,2],[15,3,15,7],[15,0,15,2],[10,1,10,2],[12,1,12,2],[14,0,14,7],[7,1,7,7],[8,1,8,2],[30,6,30,7],[31,6,31,7],[43,0,43,1],[32,6,32,7],[33,6,33,7],[30,2,30,5],[36,6,36,7],[31,2,31,5],[32,2,32,5],[33,2,33,5],[34,2,34,5],[35,6,35,7],[34,6,34,7],[36,0,36,1],[39,0,39,1],[40,0,40,1],[40,2,40,3],[40,4,40,5],[40,6,40,7],[35,0,35,1],[31,0,31,1],[32,0,32,1],[67,6,67,7],[60,0,60,7],[52,0,52,1],[53,0,53,1],[50,0,50,1],[65,6,65,7],[66,6,66,7],[50,4,50,5],[50,6,50,7],[51,4,51,5],[51,6,51,7],[64,6,64,7],[63,6,63,7],[53,6,53,7],[51,2,51,3],[50,2,50,3],[62,6,62,7],[57,0,57,2],[61,6,61,7],[58,5,58,7],[58,0,58,4],[57,3,57,7],[53,2,53,3],[53,4,53,5],[54,0,54,7],[51,0,51,1],[49,4,49,5],[49,6,49,7],[29,6,29,7],[48,6,48,7],[48,0,48,1],[48,2,48,3],[48,4,48,5],[33,0,33,1],[30,0,30,1],[49,2,49,3],[49,0,49,1],[52,2,52,3],[52,4,52,5],[52,6,52,7],[23,6,23,7],[20,0,20,1],[20,2,20,3],[28,0,28,1],[28,2,28,7],[29,0,29,1],[20,4,20,5],[20,6,20,7],[26,6,26,7],[21,0,21,1],[21,2,21,3],[21,4,21,5],[21,6,21,7],[22,0,22,1],[22,2,22,3],[22,4,22,5],[22,6,22,7],[24,0,24,2],[26,2,26,3],[26,4,26,5],[24,3,24,7],[11,1,11,2],[10,3,10,4],[45,0,45,1],[38,0,38,1],[47,2,47,3],[37,0,37,1],[35,2,35,5],[36,2,36,5],[37,2,37,5],[29,2,29,5],[34,0,34,1],[39,2,39,7],[38,4,38,5],[42,0,42,1],[38,2,38,3],[44,0,44,1],[46,0,46,1],[47,0,47,1],[38,6,38,7],[47,4,47,5],[47,6,47,7],[41,0,41,1],[37,6,37,7],[23,4,23,5]]}
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,{"$f":"IF(AND(HMO_EligibleEEs<>\"Enter your group size\",F14>HMO_EligibleEEs),\"Total enrolling employees higher than eligible employees. Change eligible or enrolling employees.\",\"\")","v":""}]
[]
["Company Information"]
["Company Name:",null,null,null,null,null,null,null,{"$f":"IF(H12=\"Yes\",,\"Must have a minimum of 2 enrolled for Good plan\")","v":"Must have a minimum of 2 enrolled for Good plan"}]
["Effective Date:","Select your effective date",null,null,null,null,null,null,{"$f":"IF(H13=\"Yes\",,\"Must have a minimum of 5 enrolled for Better and Best plans\")","v":"Must have a minimum of 5 enrolled for Better and Best plans"}]
["Employer Contribution for Employees","Select employer contribution for employees",null,null,null,"Enrolling Employees",null,null,{"$f":"IF(OR(AND(OR(HMO_EligibleEEs=\"Enter your group size\",HMO_EligibleEEs<10),OR(B13=\"Enhanced Life $50,000\",B13=\"Enhanced Life $100,000\",B13=\"Enhanced Life $150,000\")),AND((SUM(G13)<10),OR(B13=\"Enhanced Life $50,000\",B13=\"Enhanced Life $100,000\",B13=\"Enhanced Life $150,000\"))),\"Enhanced Life is only available for CoPower ONE plans with 10+ enrolling employees.\",\"\")","v":""}]
["Eligible Employees","Enter your group size",null,"Number of Single",null,0,{"$f":"IF(GroupSize>49,\"50-99\",IF(AND(GroupSize<50,GroupSize>9),\"10-49\",IF(AND(GroupSize>4,GroupSize<10),\"5-9\",\"0-4\")))","v":"0-4"}]
["Region","Select your NY DHMO Region",null,"Number of Two Party",null,0,{"$f":"SUM(F11+F12+F13)","v":0},{"$f":"IF(SUM(G12)>1,\"Yes\",\"No\")","v":"No"}]
["Life Amount2","Standard Life Amount",null,"Number of Three Party+",null,0,{"$f":"SUM(F11+F12+F13)","v":0},{"$f":"IF(SUM(G13)>4,\"Yes\",\"No\")","v":"No"},{"$f":"IF(GroupSize=0,\"\",IF(OR(HMO_ERContribution=\"Select employer contribution for employees\",HMO_EligibleEEs=\"Enter your group size\"),\"Incomplete information. Select employer contribution / Enter eligible employees.\",IF(HMO_ERContribution=\"51-99% (51+ Eligible)\",IF((0.75*HMO_EligibleEEs)>GroupSize,\"Employee participation below 75%. CoPower ONE Non-Vol requires minimum 75% participation with 51-99% employer contribution for employees.\",\"\"),IF(HMO_ERContribution=\"75-99% (2-50 Eligible)\",IF((0.75*HMO_EligibleEEs)>GroupSize,\"Employee participation below 75%. CoPower ONE Non-Vol requires minimum 75% participation with 75-99% employer contribution for employees.\",\"\"),IF(HMO_EligibleEEs<>GroupSize,\"Employee Participation not 100%. CoPower ONE Non-Vol requires 100% participation with 100% employer contribution for employees.\",\"\")))))","v":""}]
[null,null,null,"Total Enrolling Employees",null,{"$f":"F13+F12+EECOunt_HMO_Single","v":0},null,null,null,null,null,{"$f":"IF(OR(I8=\"Must have a minimum of 2 enrolled for Good plan\",I5=\"Total enrolling employees higher than eligible employees. Change eligible or enrolling employees.\",I10=\"Enhanced Life is only available for CoPower ONE plans with 10+ enrolling employees.\",I13<>\"\"),1,0)","v":1}]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(I9=\"Must have a minimum of 5 enrolled for Better and Best plans\",I10=\"Enhanced Life is only available for CoPower ONE plans with 10+ enrolling employees.\",I5=\"Total enrolling employees higher than eligible employees. Change eligible or enrolling employees.\",I13<>\"\"),1,0)","v":1}]
["Cost Comparison - Monthly Rates"]
[]
[{"$f":"CONCATENATE(B12,B13,G11)","v":"Select your NY DHMO RegionStandard Life Amount0-4"},null,"Good",null,"Better",null,"Best"]
[]
["Single",null,{"$f":"IF(L14=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,2,FALSE),\"\"))","v":""},null,{"$f":"IF(L15=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,5,FALSE),\"\"))","v":""},null,{"$f":"IF(L15=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,8,FALSE),\"\"))","v":""}]
["Two Party",null,{"$f":"IF(L14=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,3,FALSE),\"\"))","v":""},null,{"$f":"IF(L15=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,6,FALSE),\"\"))","v":""},null,{"$f":"IF(L15=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,9,FALSE),\"\"))","v":""}]
["Three Party+",null,{"$f":"IF(L14=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,4,FALSE),\"\"))","v":""},null,{"$f":"IF(L15=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,7,FALSE),\"\"))","v":""},null,{"$f":"IF(L15=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_HMO,10,FALSE),\"\"))","v":""}]
["Total Cost",null,{"$f":"IFERROR(SUM((C20*F11)+(C21*F12)+(C22*F13)),\"\")","v":""},null,{"$f":"IFERROR(SUM((E20*F11)+(E21*F12)+(E22*F13)),\"\")","v":""},null,{"$f":"IFERROR(SUM((G20*F11)+(G21*F12)+(G22*F13)),\"\")","v":""}]
[]
["Benefit Comparison"]
[]
[null,null,"Good",null,"Better",null,"Best"]
[null,null,"In Network","Out of Network","In Network","Out of Network","In Network","Out of Network"]
["DHMO - DeltaCare® USA",null,"DeltaCare® USA Plan 13B"]
["Calendar Maximum",null,"None",null,null,null,"None"]
["Deductible",null,"None",null,null,null,"None"]
["Diagnostic & Preventive ",null,"Exams, x-rays, cleanings, and flouride treatments",null,null,null,"No cost"]
["Restorative",null,"Fillings (amalgan cost per surface)\nCrown – porcelain fused to high noble metal; full cast high noble metal",null,null,null,"No cost\n$355 copay"]
["Periodontics",null,"Periodontic scaling & root planing—four or more teeth per quadrant",null,null,null,"$50 copay"]
["Endodontics",null,"Root canal – anterior (excluding final restoration)\nRoot canal – molar (excluding final restoration)",null,null,null,"$95 copay\n$335 copay"]
["Oral Surgery",null,"Extraction, erupted tooth or exposed root\nRemoval of impacted tooth – completely boney",null,null,null,"$5 copay\n$95 copay"]
["Prosthodontics",null,"Complete denture – maxillary\nMaxillary partial denture – resin base",null,null,null,"$285 copay\n$245 copay"]
["Orthodontics",null,"Child\nAdult",null,null,null,"$1,900 copay\n$2,100 copay"]
[null,null,"Good",null,"Better",null,"Best"]
["Vision - Vision Service Plan"]
["Annual Copayment",null,"$25 exam/$25 materials",null,"$10 exam/$25 materials",null,"$10 exam/$25 materials"]
["Eye Exam",null,"Covered in full*","Reimbursed \nup to $45","Covered in full*","Reimbursed \nup to $45","Covered in full*","Reimbursed \nup to $45"]
["Single-Vision Lenses",null,"Covered in full*","Reimbursed\nup to $30","Covered in full*","Reimbursed\nup to $30","Covered in full*","Reimbursed\nup to $30"]
["Bifocal Lenses",null,"Covered in full*","Reimbursed \nup to $50","Covered in full*","Reimbursed \nup to $50","Covered in full*","Reimbursed \nup to $50"]
["Trifocal Lenses",null,"Covered in full*","Reimbursed\nup to $65","Covered in full*","Reimbursed\nup to $65","Covered in full*","Reimbursed\nup to $65"]
["Frames",null,"$150 allowance","Reimbursed \nup to $70","$150 allowance","Reimbursed \nup to $70","$175 allowance","Reimbursed \nup to $70"]
["Contact Lenses",null,"$150 allowance","Reimbursed\nup to $105","$150 allowance","Reimbursed\nup to $105","$175 allowance","Reimbursed\nup to $105"]
["Vision - Frequency"]
["Eye Exam",null,"12 months",null,"12 months",null,"12 months"]
["Lenses",null,"24 months",null,"12 months",null,"12 months"]
["Frames",null,"24 months",null,"24 months",null,"12 months"]
["Contact Lenses \n(in lieu of lenses and a frame)",null,"24 months",null,"12 months",null,"12 months"]
["Life - UNUM"]
["Basic Group Term Life \nwith AD&D and EAP",null,{"$f":"IF($B$13=\"Standard Life Amount\",\"$15,000 policy\",$B$13)","v":"$15,000 policy"},null,{"$f":"IF($B$13=\"Standard Life Amount\",\"$20,000 policy\",$B$13)","v":"$20,000 policy"},null,{"$f":"IF($B$13=\"Standard Life Amount\",\"$25,000 policy\",$B$13)","v":"$25,000 policy"}]
["1 1-year rate guarantee."]
["2 Employers with 10 or more enrolling employees have the option of substituting the standard group term life policy amounts with either a $50,000, $100,000 or $150,000 policy for an additional charge."]
["* After Copay"]
["Presented by"]
["**Enter your contact information here.**",null,null,null,null,"License #"]
[]
["This document is not meant to replace a quote and does not include all exclusions, limitations or program guidelines. While the information and rates provided here are believed to be accurate as of the print date, they are subject to change without notice. For the most up-to-date information, contact CoPower. CoPower ONE plans are not available to groups currently insured with UNUM."]

{"sheet":"CoPower ONE DPPO","index":2,"n_rows":64,"n_cols":12,"rows_kept":64,"cut":false,"hidden":false,"merged":[[62,0,62,9],[47,8,47,9],[12,10,15,10],[10,1,10,2],[20,2,20,3],[20,4,20,5],[5,10,7,10],[35,4,35,5],[23,2,23,3],[10,10,11,10],[38,8,38,9],[14,4,14,5],[28,6,28,7],[28,4,28,5],[22,6,22,7],[24,6,24,7],[16,0,16,9],[24,2,24,3],[19,4,19,5],[19,6,19,7],[20,6,20,7],[21,6,21,7],[28,2,28,3],[24,8,24,9],[19,8,19,9],[52,2,52,3],[52,4,52,5],[53,6,53,7],[38,2,38,3],[38,4,38,5],[51,6,51,7],[40,2,40,3],[36,6,36,7],[53,8,53,9],[49,4,49,5],[40,8,40,9],[50,2,50,3],[51,2,51,3],[51,8,51,9],[50,6,50,7],[37,8,37,9],[36,4,36,5],[36,8,36,9],[37,2,37,3],[50,8,50,9],[37,4,37,5],[37,6,37,7],[39,6,39,7],[39,8,39,9],[36,2,36,3],[37,0,37,1],[39,0,39,1],[48,0,48,1],[49,0,49,1],[48,2,48,3],[49,2,49,3],[46,0,46,1],[40,4,40,5],[39,4,39,5],[47,2,47,3],[47,4,47,5],[45,0,45,1],[48,8,48,9],[49,8,49,9],[35,6,35,7],[70,8,70,9],[64,8,64,9],[65,8,65,9],[66,8,66,9],[67,8,67,9],[55,0,55,9],[63,0,63,9],[68,8,68,9],[69,8,69,9],[60,0,60,2],[56,0,56,9],[57,0,57,9],[61,0,61,6],[61,7,61,9],[60,3,60,9],[53,0,53,1],[53,2,53,3],[53,4,53,5],[36,0,36,1],[40,0,40,1],[41,0,41,1],[51,0,51,1],[38,6,38,7],[48,4,48,5],[43,0,43,1],[44,0,44,1],[51,4,51,5],[38,0,38,1],[50,4,50,5],[50,0,50,1],[49,6,49,7],[48,6,48,7],[39,2,39,3],[42,0,42,1],[47,6,47,7],[34,0,34,1],[33,8,33,9],[28,8,28,9],[30,2,30,5],[34,8,34,9],[32,0,32,1],[30,6,30,9],[35,8,35,9],[20,0,20,1],[25,6,25,7],[25,4,25,5],[22,4,22,5],[21,4,21,5],[25,8,25,9],[22,2,22,3],[35,0,35,1],[22,8,22,9],[19,2,19,3],[13,4,13,5],[12,4,12,5],[19,11,21,11],[33,0,33,1],[24,4,24,5],[20,8,20,9],[30,0,30,1],[31,0,31,1],[15,4,15,5],[52,6,52,7],[52,8,52,9],[40,6,40,7],[7,3,7,9],[7,0,7,2],[17,3,17,9],[17,0,17,2],[26,3,26,9],[26,0,26,2],[23,8,23,9],[21,2,21,3],[23,6,23,7],[8,1,8,9],[14,1,14,2],[23,4,23,5],[21,8,21,9],[9,1,9,2],[23,0,23,1],[21,0,21,1],[12,1,12,2],[13,1,13,2],[22,0,22,1],[24,0,24,1],[11,1,11,2]]}
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(PPO_EligibleEEs<>\"Enter your group size\",G16>PPO_EligibleEEs),\"Total enrolling employees higher than eligible employees. Change eligible or enrolling employees.\",\"\")","v":""}]
[]
["Company Information"]
["Company Name:",null,null,null,null,null,null,null,null,null,{"$f":"IF(J14=\"Yes\",\"\",\"Must have a minimum of 2 enrolled for Good plan\")","v":"Must have a minimum of 2 enrolled for Good plan"}]
["Effective Date:","Select your effective date",null,null,null,null,null,null,null,null,{"$f":"IF(J15=\"Yes\",\"\",\"Must have a minimum of 5 enrolled for Better, Better Plus and Best plans\")","v":"Must have a minimum of 5 enrolled for Better, Better Plus and Best plans"}]
["Employer Contribution for Employees","Select employer contribution for employees",null,null,null,null,null,null,null,null,{"$f":"IF(OR(AND(OR(PPO_EligibleEEs=\"Enter your group size\",PPO_EligibleEEs<10),OR(B15=\"Enhanced Life $50,000\",B15=\"Enhanced Life $100,000\",B15=\"Enhanced Life $150,000\")),AND((SUM(I14)<10),OR(B15=\"Enhanced Life $50,000\",B15=\"Enhanced Life $100,000\",B15=\"Enhanced Life $150,000\"))),\"Enhanced Life is only available for CoPower ONE plans with 10+ enrolling employees.\",\"\")","v":""}]
["Eligible Employees","Enter your group size",null,null,null,null,"Enrolling Employees",null,null,null,null,{"$f":"IF(OR(K9<>\"\",K11<>\"\",K6<>\"\",K13<>\"\"),1,0)","v":1}]
["Region","Select your NY DPPO Region",null,null,"Number of Single",null,0,null,{"$f":"IF(GroupSize>49,\"50-99\",IF(AND(GroupSize<50,GroupSize>9),\"10-49\",IF(AND(GroupSize>4,GroupSize<10),\"5-9\",IF(GroupSize>1,\"2-4\",\"\"))))","v":""},null,{"$f":"IF(GroupSize=0,\"\",IF(OR(PPO_ERContribution=\"Select employer contribution for employees\",PPO_EligibleEEs=\"Enter your group size\"),\"Incomplete information. Select employer contribution / Enter eligible employees.\",IF(PPO_ERContribution=\"51-99% (51+ Eligible)\",IF((0.75*PPO_EligibleEEs)>GroupSize,\"Employee participation below 75%. CoPower ONE Non-Vol requires minimum 75% participation with 51-99% employer contribution for employees.\",\"\"),IF(PPO_ERContribution=\"75-99% (2-50 Eligible)\",IF((0.75*PPO_EligibleEEs)>GroupSize,\"Employee participation below 75%. CoPower ONE Non-Vol requires minimum 75% participation with 75-99% employer contribution for employees.\",\"\"),IF(PPO_EligibleEEs<>GroupSize,\"Employee Participation not 100%. CoPower ONE Non-Vol requires 100% participation with 100% employer contribution for employees.\",\"\")))))","v":""},{"$f":"IF(OR(K9<>\"\",K10<>\"\",K11<>\"\",K6<>\"\",K13<>\"\"),1,0)","v":1}]
["SIC Level","Select your SIC Level",null,null,"Number of Two Party",null,0,null,{"$f":"SUM(G13+G14+G15)","v":0},{"$f":"IF(SUM(I14)>1,\"Yes\",\"No\")","v":"No"}]
["Life Amount2","Standard Life Amount",null,null,"Number of Three Party+",null,0,null,{"$f":"SUM(G13+G14+G15)","v":0},{"$f":"IF(SUM(I15)>4,\"Yes\",\"No\")","v":"No"}]
[null,null,null,null,"Total Enrolling Employees",null,{"$f":"EECount_PPO_Single+G14+G15","v":0}]
[]
["Cost Comparison - Monthly Rates"]
[]
[{"$f":"CONCATENATE(B13,B14,B15,I13)","v":"Select your NY DPPO RegionSelect your SIC LevelStandard Life Amount"},{"$f":"SUM(CPPPO_EECheck)","v":0},"Good",null,"Better",null,"Better Plus",null,"Best"]
[]
["Single",null,{"$f":"IF(L12=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,2,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,5,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,8,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,11,FALSE),\"\"))","v":""}]
["Two Party",null,{"$f":"IF(L12=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,3,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,6,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,9,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,12,FALSE),\"\"))","v":""}]
["Three Party+",null,{"$f":"IF(L12=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,4,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,7,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,10,FALSE),\"\"))","v":""},null,{"$f":"IF(L13=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_Selection,List_RateTable_PPO,13,FALSE),\"\"))","v":""}]
["Total Cost",null,{"$f":"IFERROR(SUM((C22*$G$13)+(C23*$G$14)+(C24*$G$15)),\"\")","v":""},null,{"$f":"IFERROR(SUM((E22*$G$13)+(E23*$G$14)+(E24*$G$15)),\"\")","v":""},null,{"$f":"IFERROR(SUM((G22*$G$13)+(G23*$G$14)+(G24*$G$15)),\"\")","v":""},null,{"$f":"IFERROR(SUM((I22*$G$13)+(I23*$G$14)+(I24*$G$15)),\"\")","v":""}]
[]
["Benefit Comparison"]
[]
[null,null,"Good",null,"Better",null,"Better Plus",null,"Best"]
[null,null,"In Network","Out of Network","In Network","Out of Network","In Network","Out of Network","In Network","Out of Network"]
["DPPO - Delta Dental",null,"Delta Dental DPPO3",null,null,null,"Delta Dental DPPO + Premier4"]
["Calendar Maximum (per patient)",null,"$1,000","$750","$1,500","$1,250","$1,500","$1,250","$2,000","$1,500"]
["Deductible (per patient)",null,"$50","$75","$50","$75","$50","$75","$50","$75"]
["Deductible Waived for Diagnostic & Preventive",null,"Yes","No","Yes","No","Yes","No","Yes"]
["Diagnostic and\nPreventive Services",null,"100%","50%","100%","80%","100%","80%","100%"]
["Basic, Oral Surgery, \nEndodontics and Periodontics",null,"80%","50%","80%",null,"80%",null,"80%"]
["Major Services",null,"50%",null,"50%",null,"50%",null,"50%"]
["Orthodontics-Children Only\n(Available to groups with 5+ enrolled)",null,"Not available",null,"50% lifetime max $1,000",null,"50% lifetime max $1,000",null,"50% lifetime max $1,000"]
[null,null,"Good",null,"Better",null,"Better Plus",null,"Best"]
["Vision - Vision Service Plan"]
["Annual Copayment",null,"$25 exam/$25 materials",null,"$10 exam/$25 materials",null,"$10 exam/$25 materials",null,"$10 exam/$25 materials"]
["Eye Exam",null,"Covered in full*","Reimbursed \nup to $45","Covered in full*","Reimbursed \nup to $45","Covered in full*","Reimbursed \nup to $45","Covered in full*","Reimbursed \nup to $45"]
["Single-Vision Lenses",null,"Covered in full*","Reimbursed\nup to $30","Covered in full*","Reimbursed\nup to $30","Covered in full*","Reimbursed\nup to $30","Covered in full*","Reimbursed\nup to $30"]
["Bifocal Lenses",null,"Covered in full*","Reimbursed \nup to $50","Covered in full*","Reimbursed \nup to $50","Covered in full*","Reimbursed \nup to $50","Covered in full*","Reimbursed \nup to $50"]
["Trifocal Lenses",null,"Covered in full*","Reimbursed\nup to $65","Covered in full*","Reimbursed\nup to $65","Covered in full*","Reimbursed\nup to $65","Covered in full*","Reimbursed\nup to $65"]
["Frames",null,"$150 allowance","Reimbursed \nup to $70","$150 allowance","Reimbursed \nup to $70","$150 allowance","Reimbursed \nup to $70","$175 allowance","Reimbursed \nup to $70"]
["Contact Lenses",null,"$150 allowance","Reimbursed\nup to $105","$150 allowance","Reimbursed\nup to $105","$150 allowance","Reimbursed\nup to $105","$175 allowance","Reimbursed\nup to $105"]
["Vision - Frequency"]
["Eye Exam",null,"12 months",null,"12 months",null,"12 months",null,"12 months"]
["Lenses",null,"24 months",null,"12 months",null,"12 months",null,"12 months"]
["Frames",null,"24 months",null,"24 months",null,"24 months",null,"12 months"]
["Contact Lenses \n(in lieu of lenses and a frame)",null,"24 months",null,"12 months",null,"12 months",null,"12 months"]
["Life - UNUM"]
["Basic Group Term Life \nwith AD&D and EAP",null,{"$f":"IF($B$15=\"Standard Life Amount\",\"$15,000 policy\",$B$15)","v":"$15,000 policy"},null,{"$f":"IF($B$15=\"Standard Life Amount\",\"$20,000 policy\",$B$15)","v":"$20,000 policy"},null,{"$f":"IF($B$15=\"Standard Life Amount\",\"$20,000 policy\",$B$15)","v":"$20,000 policy"},null,{"$f":"IF($B$15=\"Standard Life Amount\",\"$25,000 policy\",$B$15)","v":"$25,000 policy"}]
["1 1-year rate guarantee.   "]
["2 Employers with 10 or more enrolling employees have the option of substituting the standard group term life policy amounts with either a $50,000, $100,000 or $150,000 policy for an additional charge."]
["3 Delta Dental DPPO: All dentists (in- and out-of-network) are reimbursed at the lesser of the submitted charge or the DPPO provider's contracted fee."]
["4 Delta Dental DPPO + Premier: DPPO dentists are reimbursed at the lesser of the submitted charge or the DPPO provider's contracted fee. Delta Dental Premier dentists are reimbursed at the lesser of the submitted charge or the Premier provider's contracted fee. Non-contracted dentists are reimbursed at the lesser of the submitted charge or the plan contract allowance."]
["* After Copay"]
[]
["Presented by"]
["**Enter your contact information here.**",null,null,null,null,null,null,"License #"]
[]
["This document is not meant to replace a quote and does not include all exclusions, limitations or program guidelines. While the information and rates provided here are believed to be accurate as of the print date, they are subject to change without notice. For the most up-to-date information, contact CoPower. CoPower ONE plans are not available to groups currently insured with UNUM."]

{"sheet":"CoPower ONE Non-MPB Dual Choice","index":3,"n_rows":81,"n_cols":15,"rows_kept":81,"cut":false,"hidden":false,"merged":[[79,0,79,9],[41,6,41,7],[22,6,22,7],[30,0,30,2],[28,8,28,9],[39,6,39,7],[12,10,14,10],[14,4,14,5],[40,2,40,3],[40,4,40,5],[23,6,23,7],[4,10,7,10],[78,7,78,9],[21,4,21,5],[66,2,66,3],[66,4,66,5],[65,6,65,7],[66,6,66,7],[53,2,53,3],[73,0,73,9],[69,0,69,9],[71,0,71,9],[42,2,42,9],[41,8,41,9],[39,4,39,5],[32,8,32,9],[34,6,34,9],[40,8,40,9],[40,6,40,7],[38,0,38,1],[37,0,37,1],[41,0,41,1],[41,2,41,3],[41,4,41,5],[40,0,40,1],[12,11,14,13],[12,1,12,2],[13,1,13,2],[14,1,14,2],[15,1,15,2],[39,8,39,9],[21,8,21,9],[22,8,22,9],[23,8,23,9],[26,8,26,9],[25,8,25,9],[27,6,27,7],[29,8,29,9],[28,0,28,1],[28,2,28,3],[28,4,28,5],[23,0,23,1],[23,4,23,5],[21,6,21,7],[55,6,55,7],[53,6,53,7],[37,8,37,9],[54,0,54,1],[27,2,27,3],[27,4,27,5],[49,2,49,8],[50,2,50,8],[42,0,42,1],[51,2,51,8],[43,2,43,8],[44,0,44,1],[46,2,46,8],[48,2,48,8],[45,2,45,8],[44,2,44,8],[48,0,48,1],[49,0,49,1],[35,0,35,1],[27,8,27,9],[43,0,43,1],[34,0,34,1],[34,2,34,5],[39,0,39,1],[45,0,45,1],[46,0,46,1],[51,0,51,1],[50,0,50,1],[53,0,53,1],[47,0,47,1],[55,2,55,3],[55,4,55,5],[56,0,56,1],[53,4,53,5],[55,0,55,1],[85,8,85,9],[86,8,86,9],[87,8,87,9],[80,0,80,9],[81,8,81,9],[82,8,82,9],[83,8,83,9],[6,0,6,9],[84,8,84,9],[67,0,67,1],[68,0,68,1],[68,2,68,3],[68,4,68,5],[27,0,27,1],[64,8,64,9],[68,8,68,9],[65,0,65,1],[68,6,68,7],[64,0,64,1],[64,2,64,3],[64,4,64,5],[76,3,76,9],[77,0,77,9],[76,0,76,2],[72,0,72,9],[65,8,65,9],[66,0,66,1],[78,0,78,6],[65,2,65,3],[65,4,65,5],[47,2,47,8],[9,1,9,2],[32,2,32,3],[32,4,32,5],[36,0,36,1],[32,6,32,7],[38,8,38,9],[22,0,22,1],[22,2,22,3],[22,4,22,5],[20,6,20,7],[19,6,19,7],[19,2,19,3],[21,0,21,1],[64,6,64,7],[66,8,66,9],[62,0,62,1],[60,0,60,1],[9,10,11,10],[16,0,16,9],[12,4,12,5],[13,4,13,5],[8,1,8,9],[10,6,10,7],[15,10,17,10],[15,4,15,5],[17,0,17,2],[10,1,10,2],[11,1,11,2],[7,3,7,9],[17,3,17,9],[30,3,30,9],[7,0,7,2],[20,2,20,3],[20,4,20,5],[24,8,24,9],[25,0,25,1],[25,2,25,3],[25,4,25,5],[19,4,19,5],[24,0,24,1],[26,0,26,1],[26,2,26,3],[19,8,19,9],[20,0,20,1],[20,8,20,9],[26,4,26,5],[28,6,28,7],[23,2,23,3],[29,4,29,5],[25,6,25,7],[26,6,26,7],[21,2,21,3],[67,2,67,3],[67,4,67,5],[67,6,67,7],[67,8,67,9],[54,2,54,3],[54,4,54,5],[54,6,54,7],[54,8,54,9],[52,0,52,1],[63,0,63,1],[63,2,63,3],[63,4,63,5],[63,8,63,9],[63,6,63,7],[57,0,57,1],[58,0,58,1],[59,0,59,1],[61,0,61,1],[62,2,62,3],[62,4,62,5],[62,6,62,7],[62,8,62,9],[55,8,55,9],[53,8,53,9]]}
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(HP_EligibleEEs<>\"Enter your group size\",GroupSize_DualTotal>HP_EligibleEEs),\"Total enrolling employees higher than eligible employees. Change eligible or enrolling employees.\",\"\")","v":""}]
[]
[]
["Company Information"]
["Company Name:",null,null,null,null,null,null,null,null,null,{"$f":"IF(SUM(GroupSize_DualTotal=0),\"\",IF(J16=\"Yes\",\"\",\"Dual Choice requires a minimum of 4 enrolled. \"))","v":""}]
["Effective Date:","Select your effective date",null,null,{"$f":"IF(GroupSize_DualTotal>49,\"50-99\",IF(AND(GroupSize_DualTotal<50,GroupSize_DualTotal>9),\"10-49\",IF(AND(GroupSize_DualTotal>4,GroupSize_DualTotal<10),\"5-9\",IF(GroupSize_DualTotal>1,\"2-4\",\"\"))))","v":""},null,null,null,{"$f":"IF(OR(K9<>\"\",K10<>\"\",K16<>\"\",K5<>\"\",L13<>\"\"),1,0)","v":0},"Good Eligible",{"$f":"IF(GroupSize_DualTotal=0,\"\",IF(I15=\"Yes\",\"\",\"CoPower ONE Good: Dual Choice requires a minimum of 2 enrolled on DHMO and on DPPO.\"))","v":""}]
["Employer Contribution for Employees","Select employer contribution for employees",null,null,{"$f":"IF(GroupSize_DualPPO>49,\"50-99\",IF(AND(GroupSize_DualPPO<50,GroupSize_DualPPO>9),\"10-49\",IF(AND(GroupSize_DualPPO>4,GroupSize_DualPPO<10),\"5-9\",IF(GroupSize_DualPPO>1,\"2-4\",\"\"))))","v":""},{"$f":"SUM(GroupSize_DualPPO+GroupSize_DualHMO)","v":0},"Enrolling Employees",null,{"$f":"IF(OR(K9<>\"\",K10<>\"\",K13<>\"\",K16<>\"\",K5<>\"\",L13<>\"\"),1,0)","v":0},"Better/BetterPlus/Best Eligible"]
["Eligible Employees","Enter your group size",null,null,{"$f":"IF(GroupSize_DualHMO>49,\"50-99\",IF(AND(GroupSize_DualHMO<50,GroupSize_DualHMO>9),\"10-49\",IF(AND(GroupSize_DualHMO>1,GroupSize_DualHMO<10),\"2-9\",\"\")))","v":""},null,"DPPO","DHMO"]
["DPPO Region","Select your NY DPPO Region",null,null,"Number of Single",null,0,0,{"$f":"IF(SUM(G13:G15)<2,\"0\",\"1\")","v":"0"},{"$f":"IF(GroupSize_DualPPO<5,\"0\",\"1\")","v":"0"},{"$f":"IF(GroupSize_DualTotal=0,\"\",IF(J15=\"Yes\",\"\",\"CoPower ONE Better, Better Plus, and Best: Dual Choice requires a minimum of 5 enrolled on DPPO and 2 enrolled on DHMO.\"))","v":""},{"$f":"IF(GroupSize_DualTotal=0,\"\",IF(OR(Dual_ERContribution=\"Select employer contribution for employees\",HP_EligibleEEs=\"Enter your group size\"),\"Incomplete information. Select employer contribution / Enter eligible employees.\",IF(Dual_ERContribution=\"51-99% (51+ Eligible)\",IF((0.75*HP_EligibleEEs)>GroupSize_DualTotal,\"Employee participation below 75%. CoPower ONE Non-Vol requires minimum 75% participation with 51-99% employer contribution for employees.\",\"\"),IF(Dual_ERContribution=\"75-99% (2-50 Eligible)\",IF((0.75*HP_EligibleEEs)>GroupSize_DualTotal,\"Employee participation below 75%. CoPower ONE Non-Vol requires minimum 75% participation with 75-99% employer contribution for employees.\",\"\"),IF(GroupSize_DualTotal<>HP_EligibleEEs,\"Employee Participation not 100%. CoPower ONE Non-Vol requires 100% participation with 100% employer contribution for employees.\",\"\")))))","v":""}]
["DHMO Region","Select your NY DHMO Region",null,null,"Number of Two Party",null,0,0,{"$f":"IF(SUM(H13:H15)<2,\"0\",\"1\")","v":"0"},{"$f":"IF(GroupSize_DualHMO<2,\"0\",\"1\")","v":"0"}]
["SIC Level","Select your SIC Level",null,null,"Number of Three Party+",null,0,0,{"$f":"IF(SUM(I13+I14)>=2,\"Yes\",\"No\")","v":"No"},{"$f":"IF(SUM(J13+J14)>=2,\"Yes\",\"No\")","v":"No"}]
["Life Amount3","Standard Life Amount",null,null,"Total Enrolling Employees",null,{"$f":"SUM(G13+G14+G15)","v":0},{"$f":"SUM(H13+H14+H15)","v":0},null,{"$f":"IF(GroupSize_DualTotal>3,\"Yes\",\"No\")","v":"No"},{"$f":"IF(OR(AND(OR(PPO_EligibleEEs=\"Enter Number of Employees\",PPO_EligibleEEs=\"2-9 Employees\"),OR(B16=\"Enhanced Life $50,000\",B16=\"Enhanced Life $100,000\",B16=\"Enhanced Life $150,000\")),AND((SUM(G16:H16)<10),OR(B16=\"Enhanced Life $50,000\",B16=\"Enhanced Life $100,000\",B16=\"Enhanced Life $150,000\"))),\"Enhanced Life is only available for CoPower ONE plans with 10+ enrolling employees.\",\"\")","v":""}]
["."]
["Cost Comparison - Monthly Rates"]
[]
[{"$f":"IF(OR(B16=\"Enhanced Life $50,000\",B16=\"Enhanced Life $100,000\",B16=\"Enhanced Life $150,000\"),CONCATENATE(Region_HP_PPO,SIC_HP,Life_HP,E10),CONCATENATE(Region_HP_PPO,SIC_HP,Life_HP,E11))","v":"Select your NY DPPO RegionSelect your SIC LevelStandard Life Amount"},{"$f":"IF(OR(B16=\"Enhanced Life $50,000\",B16=\"Enhanced Life $100,000\",B16=\"Enhanced Life $150,000\"),CONCATENATE(Region_HP_HMO,Life_HP,E10),CONCATENATE(Region_HP_HMO,Life_HP,E12))","v":"Select your NY DHMO RegionStandard Life Amount"},"Good",null,"Better",null,"Better Plus",null,"Best"]
["DPPO Enrollment"]
["Single",null,{"$f":"IF(I10=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,2,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,5,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,8,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,11,FALSE),\"\"))","v":""}]
["Two Party",null,{"$f":"IF(I10=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,3,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,6,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,9,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,12,FALSE),\"\"))","v":""}]
["Three Party+",null,{"$f":"IF(I10=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,4,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,7,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,10,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionPPO,List_RateTable_PPO,13,FALSE),\"\"))","v":""},null,null,{"$f":"IFERROR(IF(I10=1,\"\",IF(GroupSize_DualPPO>0,SUM(($G$13*C22)+($G$14*C23)+($G$15*C24)),0)),\"\")","v":0},{"$f":"IFERROR(IF(I11=1,\"\",IF(GroupSize_DualPPO>0,SUM(($G$13*E22)+($G$14*E23)+($G$15*E24)),0)),\"\")","v":0},{"$f":"IFERROR(IF(I11=1,\"\",IF(GroupSize_DualPPO>0,SUM(($G$13*G22)+($G$14*G23)+($G$15*G24)),0)),\"\")","v":0},{"$f":"IFERROR(IF(I11=1,\"\",IF(GroupSize_DualPPO>0,SUM(($G$13*I22)+($G$14*I23)+($G$15*I24)),0)),\"\")","v":0}]
["DHMO Enrollment"]
["Single",null,{"$f":"IF(I10=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,2,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,5,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,5,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,8,FALSE),\"\"))","v":""}]
["Two Party",null,{"$f":"IF(I10=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,3,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,6,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,6,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,9,FALSE),\"\"))","v":""}]
["Three Party+",null,{"$f":"IF(I10=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,4,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,7,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,7,FALSE),\"\"))","v":""},null,{"$f":"IF(I11=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionHMO,List_RateTable_HMO,10,FALSE),\"\"))","v":""},null,null,{"$f":"IFERROR(IF(I10=1,\"\",IF(GroupSize_DualHMO>0,SUM(($H$13*C26)+($H$14*C27)+($H$15*C28)),0)),\"\")","v":0},{"$f":"IFERROR(IF(I11=1,\"\",IF(GroupSize_DualHMO>0,SUM(($H$13*E26)+($H$14*E27)+($H$15*E28)),0)),\"\")","v":0},{"$f":"IFERROR(IF(I11=1,\"\",IF(GroupSize_DualHMO>0,SUM(($H$13*G26)+($H$14*G27)+($H$15*G28)),0)),\"\")","v":0},{"$f":"IFERROR(IF(I11=1,\"\",IF(GroupSize_DualHMO>0,SUM(($H$13*I26)+($H$14*I27)+($H$15*I28)),0)),\"\")","v":0}]
["Total Cost",null,{"$f":"IFERROR(IF(I10=1,\"\",SUM(L24+L28)),\"\")","v":0},null,{"$f":"IFERROR(IF(I11=1,\"\",SUM(M24+M28)),\"\")","v":0},null,{"$f":"IFERROR(IF(I11=1,\"\",SUM(N24+N28)),\"\")","v":0},null,{"$f":"IFERROR(IF(I11=1,\"\",SUM(O24+O28)),\"\")","v":0}]
[]
["Benefit Comparison"]
[]
[null,null,"Good",null,"Better",null,"Better Plus",null,"Best"]
[null,null,"In Network","Out of Network","In Network","Out of Network","In Network","Out of Network","In Network","Out of Network"]
["DPPO - Delta Dental",null,"Delta Dental DPPO4",null,null,null,"Delta Dental DPPO + Premier 5"]
["Calendar Maximum (per patient)",null,"$1,000","$750","$1,500","$1,250","$1,500","$1,250","$2,000","$1,500"]
["Deductible (per patient)",null,"$50","$75","$50","$75","$50","$75","$50","$75"]
["Deductible Waived for Diagnostic & Preventive",null,"Yes","No","Yes","No","Yes","No","Yes"]
["Diagnostic and\nPreventive Services",null,"100%","50%","100%","80%","100%","80%","100%"]
["Basic, Oral Surgery, \nEndodontics and Periodontics",null,"80%","50%","80%",null,"80%",null,"80%"]
["Major Services",null,"50%",null,"50%",null,"50%",null,"50%"]
["Orthodontics-Children Only\n(Available to groups with 5+ enrolled)",null,"Not available",null,"50% lifetime max $1,000",null,"50% lifetime max $1,000",null,"50% lifetime max $1,000"]
["DHMO - DeltaCare® USA",null,"DeltaCare® USA Plan 13B"]
["Calendar Maximum",null,"None",null,null,null,null,null,null,"None"]
["Deductible",null,"None",null,null,null,null,null,null,"None"]
["Diagnostic & Preventive ",null,"Exams, x-rays, cleanings, and flouride treatments",null,null,null,null,null,null,"No cost"]
["Restorative",null,"Fillings (amalgan cost per surface)\nCrown – porcelain fused to high noble metal; full cast high noble metal",null,null,null,null,null,null,"No cost\n$355 copay"]
["Periodontics",null,"Periodontic scaling & root planing—four or more teeth per quadrant",null,null,null,null,null,null,"$50 copay"]
["Endodontics",null,"Root canal – anterior (excluding final restoration)\nRoot canal – molar (excluding final restoration)",null,null,null,null,null,null,"$95 copay\n$335 copay"]
["Oral Surgery",null,"Extraction, erupted tooth or exposed root\nRemoval of impacted tooth – completely boney",null,null,null,null,null,null,"$5 copay\n$95 copay"]
["Prosthodontics",null,"Complete denture – maxillary\nMaxillary partial denture – resin base",null,null,null,null,null,null,"$285 copay\n$245 copay"]
["Orthodontics",null,"Child\nAdult",null,null,null,null,null,null,"$1,900 copay\n$2,100 copay"]
[]
[null,null,"Good",null,"Better",null,"Better Plus",null,"Best"]
["Vision - Vision Service Plan"]
["Annual Copayment",null,"$25 exam/$25 materials",null,"$10 exam/$25 materials",null,"$10 exam/$25 materials",null,"$10 exam/$25 materials"]
["Eye Exam",null,"Covered in full*","Reimbursed \nup to $45","Covered in full*","Reimbursed \nup to $45","Covered in full*","Reimbursed \nup to $45","Covered in full*","Reimbursed \nup to $45"]
["Single-Vision Lenses",null,"Covered in full*","Reimbursed\nup to $30","Covered in full*","Reimbursed\nup to $30","Covered in full*","Reimbursed\nup to $30","Covered in full*","Reimbursed\nup to $30"]
["Bifocal Lenses",null,"Covered in full*","Reimbursed \nup to $50","Covered in full*","Reimbursed \nup to $50","Covered in full*","Reimbursed \nup to $50","Covered in full*","Reimbursed \nup to $50"]
["Trifocal Lenses",null,"Covered in full*","Reimbursed\nup to $65","Covered in full*","Reimbursed\nup to $65","Covered in full*","Reimbursed\nup to $65","Covered in full*","Reimbursed\nup to $65"]
["Frames",null,"$150 allowance","Reimbursed \nup to $70","$150 allowance","Reimbursed \nup to $70","$150 allowance","Reimbursed \nup to $70","$175 allowance","Reimbursed \nup to $70"]
["Contact Lenses",null,"$150 allowance","Reimbursed\nup to $105","$150 allowance","Reimbursed\nup to $105","$150 allowance","Reimbursed\nup to $105","$175 allowance","Reimbursed\nup to $105"]
["Vision - Frequency"]
["Eye Exam",null,"12 months",null,"12 months",null,"12 months",null,"12 months"]
["Lenses",null,"24 months",null,"12 months",null,"12 months",null,"12 months"]
["Frames",null,"24 months",null,"24 months",null,"24 months",null,"12 months"]
["Contact Lenses \n(in lieu of lenses and a frame)",null,"24 months",null,"12 months",null,"12 months",null,"12 months"]
["Life - UNUM"]
["Basic Group Term Life \nwith AD&D and EAP",null,{"$f":"IF($B$16=\"Standard Life Amount\",\"$15,000 policy\",$B$16)","v":"$15,000 policy"},null,{"$f":"IF($B$16=\"Standard Life Amount\",\"$20,000 policy\",$B$16)","v":"$20,000 policy"},null,{"$f":"IF($B$16=\"Standard Life Amount\",\"$20,000 policy\",$B$16)","v":"$20,000 policy"},null,{"$f":"IF($B$16=\"Standard Life Amount\",\"$25,000 policy\",$B$16)","v":"$25,000 policy"}]
["1 Groups of 4 may elect CoPower ONE Good, with 2 enrolled employees on the DPPO plan and a minimum of 2 on the DHMO plan. Dual Choice with CoPower ONE Better, Better Plus, and Best plans requires a minimum of 5 enrolled employees on the DPPO plan and a minimum of 2 on the DHMO plan. Bundles cannot be mixed. CoPower ONE Good DPPO will pair with CoPower ONE Good DHMO. Better Plus DPPO will pair with Better DHMO. "]
["2 1-year rate guarantee"]
["3 Employers with 10 or more enrolling employees have the option of substituting the standard group term life policy amounts with either a $50,000, $100,000 or $150,000 policy for an additional charge"]
["4 Delta Dental DPPO: All dentists (in- and out-of-network) are reimbursed at the lesser of the submitted charge or the DPPO provider's contracted fee."]
["5 Delta Dental DPPO + Premier: DPPO dentists are reimbursed at the lesser of the submitted charge or the DPPO provider's contracted fee. Delta Dental Premier dentists are reimbursed at the lesser of the submitted charge or the Premier provider's contracted fee. Non-contracted dentists are reimbursed at the lesser of the submitted charge or the plan contract allowance."]
["*After Copay"]
[]
["Presented by"]
[]
["**Enter your contact information here.**",null,null,null,null,null,null,"License #"]
[]
["This document is not meant to replace a quote and does not include all exclusions, limitations or program guidelines. While the information and rates provided here are believed to be accurate as of the print date, they are subject to change without notice. For the most up-to-date information, contact CoPower. CoPower ONE plans are not available to groups currently insured with UNUM."]

{"sheet":"CoPower ONE MPB Dual Choice","index":4,"n_rows":92,"n_cols":13,"rows_kept":92,"cut":false,"hidden":false,"merged":[[10,8,11,9],[12,8,13,9],[81,0,81,7],[90,0,90,6],[91,0,91,7],[46,5,46,7],[43,2,43,4],[44,2,44,4],[45,2,45,4],[46,2,46,4],[47,2,47,7],[48,2,48,7],[49,2,49,7],[50,2,50,7],[75,2,75,7],[76,2,76,7],[77,2,77,7],[78,2,78,7],[89,5,89,7],[23,2,23,7],[25,5,25,7],[24,5,24,7],[26,5,26,7],[27,5,27,7],[28,5,28,7],[24,2,24,4],[25,2,25,4],[26,2,26,4],[27,2,27,4],[28,2,28,4],[31,5,31,7],[32,5,32,7],[33,5,33,7],[31,2,31,4],[71,5,71,7],[72,5,72,7],[73,5,73,7],[68,2,68,4],[69,2,69,4],[70,2,70,4],[71,2,71,4],[72,2,72,4],[73,2,73,4],[65,2,65,7],[66,5,66,7],[66,2,66,4],[67,2,67,7],[68,5,68,7],[69,5,69,7],[70,5,70,7],[54,6,54,7],[55,6,55,7],[56,6,56,7],[57,6,57,7],[58,6,58,7],[59,6,59,7],[60,6,60,7],[61,6,61,7],[62,6,62,7],[4,8,8,9],[9,8,9,9],[40,2,40,7],[52,2,52,7],[53,2,53,7],[32,2,32,4],[33,2,33,4],[34,5,34,7],[34,2,34,4],[36,5,36,7],[36,2,36,4],[9,1,9,7],[46,1,47,1],[48,1,50,1],[41,5,41,7],[41,2,41,4],[42,2,42,7],[43,5,43,7],[44,5,44,7],[45,5,45,7],[58,2,58,5],[59,2,59,5],[60,2,60,5],[41,0,41,1],[42,0,42,1],[56,0,56,1],[57,0,57,1],[58,0,58,1],[56,2,56,5],[57,2,57,5],[53,0,53,1],[54,0,54,1],[55,0,55,1],[96,8,96,9],[97,8,97,9],[98,8,98,9],[92,8,92,9],[93,8,93,9],[94,8,94,9],[89,0,89,4],[87,0,87,2],[80,0,80,1],[78,0,78,1],[79,0,79,1],[95,8,95,9],[80,2,80,7],[82,0,82,7],[84,0,84,7],[85,0,85,7],[76,0,76,1],[77,0,77,1],[74,0,74,1],[75,0,75,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[73,0,73,1],[66,0,66,1],[67,0,67,1],[62,0,62,1],[62,2,62,5],[59,0,59,1],[60,0,60,1],[61,0,61,1],[61,2,61,5],[43,0,43,1],[44,0,44,1],[45,0,45,1],[37,8,37,9],[38,0,38,2],[38,3,38,6],[36,0,36,1],[33,0,33,1],[34,0,34,1],[31,0,31,1],[32,0,32,1],[11,5,11,6],[12,1,12,2],[27,0,27,1],[30,0,30,1],[28,0,28,1],[25,0,25,1],[26,0,26,1],[8,3,8,6],[16,8,18,9],[24,0,24,1],[16,1,16,2],[16,3,16,4],[20,0,20,2],[13,1,13,2],[13,3,13,4],[20,3,20,6],[17,1,17,2],[14,1,14,2],[14,3,14,4],[15,1,15,2],[15,3,15,4],[8,0,8,2],[10,1,10,2],[11,1,11,2]]}
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,{"$f":"IF(AND(VOL_EligibleEEs<>\"Enter your group size\",GroupSize_DualVOLTotal>VOL_EligibleEEs),\"Total enrolling employees higher than eligible employees. Change eligible or enrolling employees.\",\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,"<= Enrolled vs Eligible Check (If Enrollled > Eligible)"]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(VolPPO_Ortho=\"With Ortho\",1,IF(DUALCHOICE_VOL=\"YES\",IF(OR(I5<>\"\",I17<>\"\"),1,0),IF(OR(I10<>\"\",I5<>\"\"),1,0)))","v":0},"PPO W/O Ortho"]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(VolPPO_Ortho=\"Without Ortho\",1,IF(DUALCHOICE_VOL=\"YES\",IF(OR(I5<>\"\",I17<>\"\",I11<>\"\"),1,0),IF(OR(E24=\"PPO With Ortho (Not Available)\",I11<>\"\",I10<>\"\",I5<>\"\"),1,0)))","v":1},"PPO W Ortho"]
["Company Information",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(DUALCHOICE_VOL=\"YES\",IF(OR(I5<>\"\",I17<>\"\",I13<>\"\"),1,0),IF(OR(I13<>\"\",I5<>\"\"),1,0))","v":0},"DHMO MPB"]
["Company Name:",null,null,null,null,null,null,null,{"$f":"IF(DUALCHOICE_VOL=\"YES\",\"\",IF(VOL_EligibleEEs=\"Enter your group size\",\"\",IF(M10=\"1\",\"\",\"CoPower ONE MPB DPPO requires a minimum of 5 enrolled.\")))","v":""},null,null,{"$f":"IF(GroupSize_DualVOLPPO<5,\"0\",\"1\")","v":"0"},{"$f":"IF(GroupSize_DualVOLPPO<5,\"0\",\"1\")","v":"0"}]
["Effective Date:","Select your effective date",null,null,null,null,null,null,{"$f":"IF(VOL_EligibleEEs=\"Enter your group size\",\"\",IF(GroupSize_DualVOLPPO>24,\"\",\"CoPower ONE MPB DPPO with Ortho requires a minimum of 25 enrolled.\"))","v":""},null,null,{"$f":"IF(GroupSize_DualVOLHMO<2,\"0\",\"1\")","v":"0"},{"$f":"IF(GroupSize_DualVOLHMO<2,\"0\",\"1\")","v":"0"}]
["Employer Contribution for Employees","Less than 75%",null,null,{"$f":"SUM(GroupSize_DualVOLPPO+GroupSize_DualVOLHMO)","v":0},"Enrolling Employees",null,null,null,null,null,{"$f":"IF(SUM(L10+L11)>=2,\"Yes\",\"No\")","v":"No"},{"$f":"IF(SUM(M10+M11)>=1,\"Yes\",\"No\")","v":"No"}]
["Eligible Employees","Enter your group size",null,null,null,"DPPO","DHMO",null,{"$f":"IF(VOL_EligibleEEs<>\"Enter your group size\",IF(M11=\"1\",\"\",\"CoPower ONE MPB DHMO requires a minimum of 2 enrolled.\"),\"\")","v":""},null,null,{"$f":"IF(OR(I17<>\"\",I5<>\"\"),1,0)","v":0},"Dual Choice MPB"]
["DPPO Region","Select your NY DPPO Region",null,"Number of Single",null,0,0,null,null,null,"<= DHMO Check (Minimum 2 Enrolled)"]
["DHMO Region","Select your NY DHMO Region",null,"Number of Two Party",null,0,0]
["SIC Level","Select your SIC Level",null,"Number of Three Party+",null,0,0]
["Dual Choice? (Requires minimum \n10+ enrollees)","No",null,"Total Enrolling Employees",null,{"$f":"SUM(F14+F15+F16)","v":0},{"$f":"SUM(G14+G15+G16)","v":0},null,{"$f":"IF(OR(DUALCHOICE_VOL=\"Select Dual Choice (Required)\",DUALCHOICE_VOL=\"No\",VOL_EligibleEEs=\"Enter your group size\"),\"\",IF(AND(GroupSize_DualVOLTotal>9,M12=\"Yes\",GroupSize_DualVOLPPO>4,GroupSize_DualVOLHMO>1),\"\",\"CoPower ONE MPB Dual Choice requires minimum of 10 enrolled, with minimum of 5 enrolled in one plan and remainder in the other.\"))","v":""},null,"<= Dual Choice: 10 total enrolled, 5 on one plan check"]
["Ortho? (Requires minimum \n25+ enrollees on DPPO)","Without Ortho"]
[]
[]
["Cost Comparison - Monthly Rates"]
[{"$f":"IF(OR(VOL_EligibleEEs=\"Enter your group size\",DUALCHOICE_VOL=\"Select Dual Choice (Required)\",VolPPO_Ortho=\"Select Ortho (Required)\"),\"\",CONCATENATE(Region_VOL_PPO,SIC_VOL,\"WithOrtho\"))","v":""},null,{"$f":"CONCATENATE(Region_VOL_PPO,SIC_VOL,\"WithOrtho\")","v":"Select your NY DPPO RegionSelect your SIC LevelWithOrtho"}]
[]
[{"$f":"IF(OR(VOL_EligibleEEs=\"Enter your group size\",DUALCHOICE_VOL=\"Select Dual Choice (Required)\",VolPPO_Ortho=\"Select Ortho (Required)\"),\"\",CONCATENATE(Region_VOL_PPO,SIC_VOL,\"WithoutOrtho\"))","v":""},{"$f":"IF(OR(VOL_EligibleEEs=\"Enter your group size\",DUALCHOICE_VOL=\"Select Dual Choice (Required)\",VolPPO_Ortho=\"Select Ortho (Required)\"),\"\",Region_VOL_HMO)","v":""},"CoPower ONE MPB"]
["DPPO MPB Enrollment",null,"DPPO Without Ortho",null,null,{"$f":"IF(GroupSize_DualVOLPPO<25,\"DPPO With Ortho (Not Available)\",IF(AND(GroupSize_DualVOLPPO>24,VolPPO_Ortho=\"Without Ortho\"),\"DPPO With Ortho (Not Selected)\",\"DPPO With Ortho\"))","v":"DPPO With Ortho (Not Available)"}]
["Single",null,{"$f":"IF(L7=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLPPO,List_RateTable_VOLPPO,2,FALSE),\"\"))","v":""},null,null,{"$f":"IF(L8=1,\"\",_xlfn.IFNA(VLOOKUP(A22,List_RateTable_VOLPPO,2,FALSE),\"\"))","v":""}]
["Two Party",null,{"$f":"IF(L7=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLPPO,List_RateTable_VOLPPO,3,FALSE),\"\"))","v":""},null,null,{"$f":"IF(L8=1,\"\",_xlfn.IFNA(VLOOKUP(A22,List_RateTable_VOLPPO,3,FALSE),\"\"))","v":""}]
["Three Party+",null,{"$f":"IF(L7=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLPPO,List_RateTable_VOLPPO,4,FALSE),\"\"))","v":""},null,null,{"$f":"IF(L8=1,\"\",_xlfn.IFNA(VLOOKUP(A22,List_RateTable_VOLPPO,4,FALSE),\"\"))","v":""}]
["Total Cost-DPPO Only",null,{"$f":"IF(C26=\"\",\"\",IFERROR(IF(L7=1,\"\",SUM(L29)),\"\"))","v":""},null,null,{"$f":"IF(F26=\"\",\"\",IFERROR(IF(L8=1,\"\",SUM(M29)),\"\"))","v":""},null,null,null,null,null,{"$f":"IFERROR(IF(L7=1,\"\",IF(GroupSize_DualVOLPPO>0,SUM(($F$14*C26)+($F$15*C27)+($F$16*C28)),0)),\"\")","v":0},{"$f":"IFERROR(IF(L8=1,\"\",IF(GroupSize_DualVOLPPO>0,SUM(($F$14*F26)+($F$15*F27)+($F$16*F28)),0)),\"\")","v":""}]
[]
["DHMO MPB Enrollment"]
["Single",null,{"$f":"IF(OR(E24=\"PPO With Ortho\",VolPPO_Ortho=\"With Ortho\"),\"\",IF(DUALCHOICE_VOL=\"YES\",IF(OR(L9=1,L13=1),\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,2,FALSE),\"\")),IF(L9=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,2,FALSE),\"\"))))","v":""},null,null,{"$f":"IF(F25=\"DPPO With Ortho (Not Selected)\",\"\",IF(OR(F25=\"DPPO With Ortho (Not Available)\",L9=1),\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,2,FALSE),\"\")))","v":""}]
["Two Party",null,{"$f":"IF(OR(E24=\"PPO With Ortho\",VolPPO_Ortho=\"With Ortho\"),\"\",IF(DUALCHOICE_VOL=\"YES\",IF(OR(L9=1,L13=1),\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,3,FALSE),\"\")),IF(L9=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,3,FALSE),\"\"))))","v":""},null,null,{"$f":"IF(F25=\"DPPO With Ortho (Not Selected)\",\"\",IF(OR(F25=\"DPPO With Ortho (Not Available)\",L9=1),\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,3,FALSE),\"\")))","v":""}]
["Three Party+",null,{"$f":"IF(OR(E24=\"PPO With Ortho\",VolPPO_Ortho=\"With Ortho\"),\"\",IF(DUALCHOICE_VOL=\"YES\",IF(OR(L9=1,L13=1),\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,4,FALSE),\"\")),IF(L9=1,\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,4,FALSE),\"\"))))","v":""},null,null,{"$f":"IF(F25=\"DPPO With Ortho (Not Selected)\",\"\",IF(OR(F25=\"DPPO With Ortho (Not Available)\",L9=1),\"\",_xlfn.IFNA(VLOOKUP(AreaSIC_SelectionVOLHMO,List_RateTable_VOLHMO,4,FALSE),\"\")))","v":""}]
["Total Cost-DHMO Only",null,{"$f":"IF(C32=\"\",\"\",IFERROR(IF(L9=1,\"\",SUM(L35)),\"\"))","v":""},null,null,{"$f":"IF(F32=\"\",\"\",IFERROR(IF(OR(F25=\"With Ortho (Not Available)\",L9=1),\"\",SUM(M35)),\"\"))","v":""},null,null,null,null,null,{"$f":"IFERROR(IF(L9=1,\"\",IF(GroupSize_DualVOLHMO>0,SUM(($G$14*C32)+($G$15*C33)+($G$16*C34)),0)),\"\")","v":0},{"$f":"IFERROR(IF(L9=1,\"\",IF(GroupSize_DualVOLHMO>0,SUM(($G$14*F32)+($G$15*F33)+($G$16*F34)),0)),\"\")","v":0}]
[]
["Total Cost-Dual Choice MPB",null,{"$f":"IF((VOL_EligibleEEs<GroupSize_DualVOLTotal),\"\",IF(B17=\"Select Dual Choice (Required)\",\"Select Dual Choice Above\",IF(DUALCHOICE_VOL=\"No\",\"No Dual Choice\",IF(OR(GroupSize_DualVOLPPO=0,L13=1),\"Not Eligible for Dual Choice\",IFERROR(SUM(C35+C29),\"\")))))","v":"No Dual Choice"},null,null,{"$f":"IF((VOL_EligibleEEs<GroupSize_DualVOLTotal),\"\",IF(B17=\"Select Dual Choice (Required)\",\"Select Dual Choice Above\",IF(DUALCHOICE_VOL=\"No\",\"No Dual Choice\",IF(OR(GroupSize_DualVOLPPO=0,L13=1),\"Not Eligible for Dual Choice\",IFERROR(SUM(F35+F29),\"\")))))","v":"No Dual Choice"}]
[]
["Benefit Comparison"]
[]
[null,null,"CoPower ONE MPB PPO"]
[null,null,"DPPO Dentists",null,null,"Non-DPPO Dentists"]
["DPPO MPB - Delta Dental",null,"Delta Dental DPPO3"]
["Calendar Year Max (per patient)",null,"$1,500",null,null,"$1,250"]
["Calendar Year Deductible (per patient)",null,"$50",null,null,"$75"]
["Deductible Waived for Diagnostic & Preventive",null,"Yes",null,null,"No"]
["Diagnostic and\nPreventive Services","First 12 Months","100%",null,null,"80%"]
["Basic Services (Sealants, Simple Restorations, & Simple Extractions)",null,"80%"]
["Oral Surgery, \nEndodontics and Periodontics","Second 12 Months","50%"]
["Major Services",null,"50%"]
["Orthodontics-Children Only\n(Available to groups with 25+ enrolled)",null,{"$f":"IF(VolPPO_Ortho=\"Select Ortho (Required)\",\"Not Available\",IF(AND(GroupSize_DualVOLTotal>24,VolPPO_Ortho=\"Without Ortho\"),\"None (No Ortho)\",IF(AND(GroupSize_DualVOLTotal<25,VolPPO_Ortho=\"Without Ortho\"),\"Not Available\",\"50% lifetime max $1,000\")))","v":"Not Available"}]
[]
[null,null,"CoPower ONE MPB DHMO"]
["DHMO MPB - DeltaCare® USA",null,"DeltaCare® USA Plan 13B"]
["Calendar Maximum",null,"None",null,null,null,"None"]
["Deductible",null,"None",null,null,null,"None"]
["Diagnostic & Preventive ",null,"Exams, x-rays, cleanings, and flouride treatments",null,null,null,"No cost"]
["Restorative",null,"Fillings (amalgan cost per surface)\nCrown – porcelain fused to high noble metal; full cast high noble metal",null,null,null,"No cost\n$355 copay"]
["Periodontics",null,"Periodontic scaling & root planing—four or more teeth per quadrant",null,null,null,"$50 copay"]
["Endodontics",null,"Root canal – anterior (excluding final restoration)\nRoot canal – molar (excluding final restoration)",null,null,null,"$95 copay\n$335 copay"]
["Oral Surgery",null,"Extraction, erupted tooth or exposed root\nRemoval of impacted tooth – completely boney",null,null,null,"$5 copay\n$95 copay"]
["Prosthodontics",null,"Complete denture – maxillary\nMaxillary partial denture – resin base",null,null,null,"$285 copay\n$245 copay"]
["Orthodontics",null,"Child\nAdult",null,null,null,"$1,900 copay\n$2,100 copay"]
[]
[]
[null,null,"CoPower ONE MPB"]
["Vision - Vision Service Plan",null,"In Network",null,null,"Out of Network"]
["Annual Copayment",null,"$10 exam / $25 materials"]
["Eye Exam",null,"Covered in full*",null,null,"Reimbursed up to $45"]
["Single-Vision Lenses",null,"Covered in full*",null,null,"Reimbursed up to $30"]
["Bifocal Lenses",null,"Covered in full*",null,null,"Reimbursed up to $50"]
["Trifocal Lenses",null,"Covered in full*",null,null,"Reimbursed up to $65"]
["Frames",null,"$200 allowance",null,null,"Reimbursed up to $70"]
["Contact Lenses",null,"$200 allowance",null,null," Reimbursed up to $105"]
["Vision - Frequency"]
["Eye Exam",null,"12 months"]
["Lenses",null,"12 months"]
["Frames",null,"12 months"]
["Contact Lenses (in lieu of lenses and a frame)",null,"12 months"]
["Life - UNUM"]
["Basic Group Term Life with AD&D and EAP",null,"N/A"]
[]
["1 Dual choice Minimum Participation Base (MPB) Delta Dental DPPO and MPB DeltaCare® USA DHMO available for groups of 10+ enrolling - minimum of 5 enrolled in one plan and remainder in the other"]
["2 1-year rate guarantee"]
["3 Delta Dental DPPO: All dentists (in- and out-of-network) are reimbursed at the lesser of the submitted charge or the DPPO provider's contracted fee."]
["* After Copay"]
[]
["Presented by"]
[]
["**Enter your contact information here.**",null,null,null,null,"License #"]
[]
["This document is not meant to replace a quote and does not include all exclusions, limitations or program guidelines. While the information and rates provided here are believed to be accurate as of the print date, they are subject to change without notice. For the most up-to-date information, contact CoPower. CoPower ONE plans are not available to groups currently insured with UNUM."]

{"sheet":"Lists","index":5,"n_rows":134,"n_cols":16,"rows_kept":134,"cut":false,"hidden":true,"merged":[[0,10,0,12],[90,13,90,15],[0,4,0,6],[0,7,0,9],[0,13,0,15],[73,4,73,6],[73,7,73,9],[73,10,73,12],[73,13,73,15],[90,4,90,6],[90,7,90,9],[90,10,90,12],[100,13,100,15],[131,4,131,6],[100,4,100,6],[100,7,100,9],[100,10,100,12]]}
["List_Area_PPO","List_SIC",null,"List_RateTable_PPO","GOOD",null,null,"BETTER",null,null,"BETTER PLUS",null,null,"BEST"]
["Select your NY DPPO Region","Select your SIC Level",null,"Region 31Standard Life Amount5-9",33.5,59.5,82.5,42,75,108,47,86.5,124,55,99,142.5]
["Region 1",1,null,"Region 32Standard Life Amount5-9",36,66,91.5,46,83.5,120.5,51.5,96,138.5,59.5,110.5,159]
["Region 2",2,null,"Region 21Standard Life Amount5-9",42,76.5,107.5,51.5,98,141.5,59.5,113.5,163.5,68,129,187]
["Region 3",null,null,"Region 22Standard Life Amount5-9",46,86,120,57.5,109.5,158,66,126.5,183.5,76,144,210]
[null,null,null,"Region 11Standard Life Amount5-9",44,81.5,113.5,54.5,102.5,149,60.5,115,166.5,69,131,189.5]
[null,null,null,"Region 12Standard Life Amount5-9",48.5,91,127,60.5,115,167.5,67,129.5,187.5,77,147,214]
[]
[null,null,null,"Region 31Standard Life Amount10-49",33.5,59.5,82.5,42,75,108,47,86.5,124,55,99,142.5]
[null,null,null,"Region 32Standard Life Amount10-49",36,66,91.5,46,83.5,120.5,51.5,96,138.5,59.5,110.5,159]
[null,null,null,"Region 21Standard Life Amount10-49",42,76.5,107.5,51.5,98,141.5,59.5,113.5,163.5,68,129,187]
["List_EffDate","List_LifeAmounts",null,"Region 22Standard Life Amount10-49",46,86,120,57.5,109.5,158,66,126.5,183.5,76,144,210]
["Select your effective date","Standard Life Amount",null,"Region 11Standard Life Amount10-49",44,81.5,113.5,54.5,102.5,149,60.5,115,166.5,69,131,189.5]
["2023-01-01","Enhanced Life $50,000",null,"Region 12Standard Life Amount10-49",48.5,91,127,60.5,115,167.5,67,129.5,187.5,77,147,214]
["2/1/2023","Enhanced Life $100,000"]
["3/1/2023","Enhanced Life $150,000",null,"Region 31Standard Life Amount50-99",33.5,59.5,82.5,42,75,108,47,86.5,124,55,99,142.5]
["4/1/2023",null,null,"Region 32Standard Life Amount50-99",36,66,91.5,46,83.5,120.5,51.5,96,138.5,59.5,110.5,159]
["5/1/2023",null,null,"Region 21Standard Life Amount50-99",42,76.5,107.5,51.5,98,141.5,59.5,113.5,163.5,68,129,187]
["6/1/2023",null,null,"Region 22Standard Life Amount50-99",46,86,120,57.5,109.5,158,66,126.5,183.5,76,144,210]
["7/1/2023",null,null,"Region 11Standard Life Amount50-99",44,81.5,113.5,54.5,102.5,149,60.5,115,166.5,69,131,189.5]
["8/1/2023",null,null,"Region 12Standard Life Amount50-99",48.5,91,127,60.5,115,167.5,67,129.5,187.5,77,147,214]
["9/1/2023"]
["10/1/2023",null,null,"Region 31Standard Life Amount2-4",35,63,88.5,"X","X","X","X","X","X","X","X","X"]
["11/1/2023",null,null,"Region 32Standard Life Amount2-4",39,71,99,"X","X","X","X","X","X","X","X","X"]
["12/1/2023",null,null,"Region 21Standard Life Amount2-4",45,83.5,116,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 22Standard Life Amount2-4",49.5,94,129.5,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 11Standard Life Amount2-4",47,88,122,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 12Standard Life Amount2-4",52.5,98.5,137.5,"X","X","X","X","X","X","X","X","X"]
["List_Area_HMO","List_EligibleEEs"]
["Select your NY DHMO Region","Select your group size",null,"Region 31Enhanced Life $50,00010-49",{"$f":"SUM(E9+$E$92)","v":43.3},{"$f":"SUM(F9+$E$92)","v":69.3},92.3,{"$f":"SUM(H9+$H$92)","v":50.4},83.4,116.4,55.4,94.9,132.4,{"$f":"SUM(N9+$K$92)","v":62},106,149.5]
["Region 1","2-9 Employees",null,"Region 32Enhanced Life $50,00010-49",45.8,75.8,101.3,54.4,91.9,128.9,59.9,104.4,146.9,66.5,117.5,166]
["Region 2","10-99 Employees",null,"Region 21Enhanced Life $50,00010-49",51.8,86.3,117.3,59.9,106.4,149.9,67.900000000000006,121.9,171.9,75,136,194]
[null,null,null,"Region 22Enhanced Life $50,00010-49",55.8,95.8,129.80000000000001,65.900000000000006,117.9,166.4,74.400000000000006,134.9,191.9,83,151,217]
[null,null,null,"Region 11Enhanced Life $50,00010-49",53.8,91.3,123.3,62.9,110.9,157.4,68.900000000000006,123.4,174.9,76,138,196.5]
["<51 Eligible","List_ERContributiontoEE",null,"Region 12Enhanced Life $50,00010-49",58.3,100.8,136.80000000000001,68.900000000000006,123.4,175.9,75.400000000000006,137.9,195.9,84,154,221]
[null,"Select employer contribution for employees"]
["(Minimum 75 % EE Participation Required)","51-99% (51+ Eligible)",null,"Region 31Enhanced Life $100,00010-49",{"$f":"SUM(E9+$E$93)","v":57.3},{"$f":"SUM(F9+$E$93)","v":83.3},106.3,{"$f":"SUM(H9+$H$93)","v":64.400000000000006},97.4,130.4,69.400000000000006,108.9,146.4,{"$f":"SUM(N9+$K$93)","v":76},120,163.5]
["(100 % EE Participation Required)","75-99% (2-50 Eligible)",null,"Region 32Enhanced Life $100,00010-49",{"$f":"SUM(E10+$E$93)","v":59.8},89.8,115.3,68.400000000000006,105.9,142.9,73.900000000000006,118.4,160.9,80.5,131.5,180]
[null,1,null,"Region 21Enhanced Life $100,00010-49",65.8,100.3,131.30000000000001,73.900000000000006,120.4,163.9,81.900000000000006,135.9,185.9,89,150,208]
[null,null,null,"Region 22Enhanced Life $100,00010-49",69.8,109.8,143.80000000000001,79.900000000000006,131.9,180.4,88.4,148.9,205.9,97,165,231]
[null,null,null,"Region 11Enhanced Life $100,00010-49",67.8,105.3,137.30000000000001,76.900000000000006,124.9,171.4,82.9,137.4,188.9,90,152,210.5]
[null,null,null,"Region 12Enhanced Life $100,00010-49",72.3,114.8,150.80000000000001,82.9,137.4,189.9,89.4,151.9,209.9,98,168,235]
[]
[null,null,null,"Region 31Enhanced Life $150,00010-49",{"$f":"SUM(E9+$E$94)","v":71.3},97.3,120.3,{"$f":"SUM(H9+$H$94)","v":78.400000000000006},111.4,144.4,83.4,122.9,160.4,{"$f":"SUM(N9+$K$94)","v":90},134,177.5]
[null,null,null,"Region 32Enhanced Life $150,00010-49",73.8,103.8,129.30000000000001,82.4,119.9,156.9,87.9,132.4,174.9,94.5,145.5,194]
["List_VolDualChoiceSelection","List_VolOrtho",null,"Region 21Enhanced Life $150,00010-49",79.8,114.3,145.30000000000001,87.9,134.4,177.9,95.9,149.9,199.9,103,164,222]
["Select Dual Choice (Required)","Select Ortho (Required)",null,"Region 22Enhanced Life $150,00010-49",83.8,123.8,157.80000000000001,93.9,145.9,194.4,102.4,162.9,219.9,111,179,245]
["Yes","Without Ortho",null,"Region 11Enhanced Life $150,00010-49",81.8,119.3,151.30000000000001,90.9,138.9,185.4,96.9,151.4,202.9,104,166,224.5]
["No","With Ortho",null,"Region 12Enhanced Life $150,00010-49",86.3,128.80000000000001,164.8,96.9,151.4,203.9,103.4,165.9,223.9,112,182,249]
[]
[null,null,null,"Region 31Enhanced Life $50,00050-99",{"$f":"SUM(E16+$E$96)","v":41.2},{"$f":"SUM(F16+$E$96)","v":67.2},90.2,{"$f":"SUM(H16+$H$96)","v":48.6},81.599999999999994,114.6,53.6,93.1,130.6,{"$f":"SUM(N16+$K$96)","v":60.5},104.5,148]
[null,null,null,"Region 32Enhanced Life $50,00050-99",{"$f":"SUM(E17+$E$96)","v":43.7},73.7,99.2,52.6,90.1,127.1,58.1,102.6,145.1,65,116,164.5]
[null,null,null,"Region 21Enhanced Life $50,00050-99",49.7,84.2,115.2,58.1,104.6,148.1,66.099999999999994,120.1,170.1,73.5,134.5,192.5]
[null,null,null,"Region 22Enhanced Life $50,00050-99",53.7,93.7,127.7,64.099999999999994,116.1,164.6,72.599999999999994,133.1,190.1,81.5,149.5,215.5]
[null,null,null,"Region 11Enhanced Life $50,00050-99",51.7,89.2,121.2,61.1,109.1,155.6,67.099999999999994,121.6,173.1,74.5,136.5,195]
[null,null,null,"Region 12Enhanced Life $50,00050-99",56.2,98.7,134.69999999999999,67.099999999999994,121.6,174.1,73.599999999999994,136.1,194.1,82.5,152.5,219.5]
[]
[null,null,null,"Region 31Enhanced Life $100,00050-99",{"$f":"SUM(E16+$E$97)","v":52.2},78.2,101.2,{"$f":"SUM(H16+$H$97)","v":59.6},92.6,125.6,64.599999999999994,104.1,141.6,{"$f":"SUM(N16+$K$97)","v":71.5},115.5,159]
[null,null,null,"Region 32Enhanced Life $100,00050-99",54.7,84.7,110.2,63.6,101.1,138.1,69.099999999999994,113.6,156.1,76,127,175.5]
[null,null,null,"Region 21Enhanced Life $100,00050-99",60.7,95.2,126.2,69.099999999999994,115.6,159.1,77.099999999999994,131.1,181.1,84.5,145.5,203.5]
[null,null,null,"Region 22Enhanced Life $100,00050-99",64.7,104.7,138.69999999999999,75.099999999999994,127.1,175.6,83.6,144.1,201.1,92.5,160.5,226.5]
[null,null,null,"Region 11Enhanced Life $100,00050-99",62.7,100.2,132.19999999999999,72.099999999999994,120.1,166.6,78.099999999999994,132.6,184.1,85.5,147.5,206]
[null,null,null,"Region 12Enhanced Life $100,00050-99",67.2,109.7,145.69999999999999,78.099999999999994,132.6,185.1,84.6,147.1,205.1,93.5,163.5,230.5]
[]
[null,null,null,"Region 31Enhanced Life $150,00050-99",{"$f":"SUM(E16+$E$98)","v":63.2},89.2,112.2,{"$f":"SUM(H16+$H$98)","v":70.599999999999994},103.6,136.6,75.599999999999994,115.1,152.6,{"$f":"SUM(N16+$K$98)","v":82.5},126.5,170]
[null,null,null,"Region 32Enhanced Life $150,00050-99",65.7,95.7,121.2,74.599999999999994,112.1,149.1,80.099999999999994,124.6,167.1,87,138,186.5]
[null,null,null,"Region 21Enhanced Life $150,00050-99",71.7,106.2,137.19999999999999,80.099999999999994,126.6,170.1,88.1,142.1,192.1,95.5,156.5,214.5]
[null,null,null,"Region 22Enhanced Life $150,00050-99",75.7,115.7,149.69999999999999,86.1,138.1,186.6,94.6,155.1,212.1,103.5,171.5,237.5]
[null,null,null,"Region 11Enhanced Life $150,00050-99",73.7,111.2,143.19999999999999,83.1,131.1,177.6,89.1,143.6,195.1,96.5,158.5,217]
[null,null,null,"Region 12Enhanced Life $150,00050-99",78.2,120.7,{"$f":"SUM(G21+$E$98)","v":156.69999999999999},89.1,143.6,196.1,95.6,158.1,216.1,104.5,174.5,241.5]
[]
[]
[]
[null,null,null,"List_RateTable_VOLPPO","ALL PLANS"]
[null,null,null,"Region 31WithOrtho",49,95,143.5,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 32WithOrtho",53.5,105.5,160,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 21WithOrtho",62,125,188,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 22WithOrtho",70,141,211,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 11WithOrtho",69,139,208,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 12WithOrtho",76.5,156.5,234,"X","X","X","X","X","X","X","X","X"]
[]
[null,null,null,"Region 31WithoutOrtho",49,92,135,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 32WithoutOrtho",53.5,103.5,150.5,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 21WithoutOrtho",62,122,176,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 22WithoutOrtho",70,137.5,198.5,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 11WithoutOrtho",69,135.5,195.5,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 12WithoutOrtho",76.5,152.5,219.5,"X","X","X","X","X","X","X","X","X"]
[]
[]
[]
[null,null,null,"Enhanced Life Rates","GOOD",null,null,"BETTER",null,null,"BEST",null,null,"BETTER PLUS"]
[null,null,null,"$50,000 10-49 Enrolled",9.8000000000000007,null,null,8.4,null,null,7,null,null,8.4]
[null,null,null,"$100,000 10-49 Enrolled",23.8,null,null,22.4,null,null,21,null,null,22.4]
[null,null,null,"$150,000 10-49 Enrolled",37.799999999999997,null,null,36.4,null,null,35,null,null,36.4]
[]
[null,null,null,"$50,000 50-99 Enrolled",7.7,null,null,6.6000000000000005,null,null,5.5,null,null,6.6000000000000005]
[null,null,null,"$100,000 50-99 Enrolled",18.7,null,null,17.600000000000001,null,null,16.5,null,null,17.600000000000001]
[null,null,null,"$150,000 50-99 Enrolled",29.7,null,null,28.6,null,null,27.5,null,null,28.6]
[]
[]
[null,null,null,"List_RateTable_HMO","GOOD (2-99)",null,null,"BETTER (5-99)",null,null,"BEST (5-99)",null,null,"BETTER PLUS"]
[null,"DHMO Bundle Only Use!",null,"Region 1Standard Life Amount0-4",35,55.5,80.5,"X","X","X","X","X","X","X","X","X"]
[null,"DHMO Bundle Only Use!",null,"Region 2Standard Life Amount0-4",34.5,52.5,77,"X","X","X","X","X","X","X","X","X"]
[]
[null,"Dual Choice Only Use!",null,"Region 1Standard Life Amount2-9",35,55.5,80.5,39,60.5,86.5,43,65.5,94.5,"X","X","X"]
[null,"Dual Choice Only Use!",null,"Region 2Standard Life Amount2-9",34.5,52.5,77,37.5,57.5,84,42.5,62.5,91,"X","X","X"]
[]
[null,"DHMO Bundle Only Use!",null,"Region 1Standard Life Amount5-9",35,55.5,80.5,39,60.5,86.5,43,65.5,94.5,"X","X","X"]
[null,"DHMO Bundle Only Use!",null,"Region 2Standard Life Amount5-9",34.5,52.5,77,37.5,57.5,84,42.5,62.5,91,"X","X","X"]
[]
[null,null,null,"Region 1Standard Life Amount10-49",35,55.5,80.5,39,60.5,86.5,43,65.5,94.5,"X","X","X"]
[null,null,null,"Region 2Standard Life Amount10-49",34.5,52.5,77,37.5,57.5,84,42.5,62.5,91,"X","X","X"]
[]
[null,null,null,"Region 1Standard Life Amount50-99",35,55.5,80.5,39,60.5,86.5,43,65.5,94.5,"X","X","X"]
[null,null,null,"Region 2Standard Life Amount50-99",34.5,52.5,77,37.5,57.5,84,42.5,62.5,91,"X","X","X"]
[]
[null,null,null,"Region 1Enhanced Life $50,00010-49",{"$f":"SUM(E108+$E$92)","v":44.8},{"$f":"SUM(F108+$E$92)","v":65.3},{"$f":"SUM(G108+$E$92)","v":90.3},{"$f":"SUM(H108+$H$92)","v":47.4},68.900000000000006,94.9,{"$f":"SUM(K108+$K$92)","v":50},72.5,101.5,"X","X","X"]
[null,null,null,"Region 2Enhanced Life $50,00010-49",{"$f":"SUM(E109+$E$92)","v":44.3},62.3,{"$f":"SUM(G109+$E$92)","v":86.8},45.9,65.900000000000006,92.4,49.5,69.5,98,"X","X","X"]
[null,null,null,"Region 1Enhanced Life $50,00050-99",{"$f":"SUM(E108+$E$96)","v":42.7},63.2,88.2,{"$f":"SUM(H108+$H$96)","v":45.6},67.099999999999994,93.1,{"$f":"SUM(K108+$K$96)","v":48.5},71,100,"X","X","X"]
[null,null,null,"Region 2Enhanced Life $50,00050-99",42.2,60.2,84.7,44.1,64.099999999999994,90.6,48,68,96.5,"X","X","X"]
[]
[null,null,null,"Region 1Enhanced Life $100,00010-49",{"$f":"SUM(E108+$E$93)","v":58.8},79.3,{"$f":"SUM(G108+$E$93)","v":104.3},{"$f":"SUM(H108+$H$93)","v":61.4},82.9,108.9,{"$f":"SUM(K108+$K$93)","v":64},86.5,115.5,"X","X","X"]
[null,null,null,"Region 2Enhanced Life $100,00010-49",58.3,76.3,{"$f":"SUM(G109+$E$93)","v":100.8},59.9,79.900000000000006,106.4,63.5,83.5,112,"X","X","X"]
[null,null,null,"Region 1Enhanced Life $100,00050-99",{"$f":"SUM(E108+$E$97)","v":53.7},74.2,{"$f":"SUM(G108+$E$97)","v":99.2},{"$f":"SUM(H108+$H$97)","v":56.6},78.099999999999994,104.1,{"$f":"SUM(K108+$K$97)","v":59.5},82,111,"X","X","X"]
[null,null,null,"Region 2Enhanced Life $100,00050-99",53.2,71.2,{"$f":"SUM(G109+$E$97)","v":95.7},55.1,75.099999999999994,101.6,59,79,107.5,"X","X","X"]
[]
[null,null,null,"Region 1Enhanced Life $150,00010-49",{"$f":"SUM(E108+$E$94)","v":72.8},{"$f":"SUM(F108+$E$94)","v":93.3},118.3,{"$f":"SUM(H108+$H$94)","v":75.400000000000006},96.9,122.9,{"$f":"SUM(K108+$K$94)","v":78},100.5,129.5,"X","X","X"]
[null,null,null,"Region 2Enhanced Life $150,00010-49",72.3,90.3,114.8,73.900000000000006,93.9,120.4,77.5,97.5,126,"X","X","X"]
[null,null,null,"Region 1Enhanced Life $150,00050-99",{"$f":"SUM(E108+$E$98)","v":64.7},85.2,110.2,{"$f":"SUM(H108+$H$98)","v":67.599999999999994},89.1,115.1,{"$f":"SUM(K108+$K$98)","v":70.5},93,122,"X","X","X"]
[null,null,null,"Region 2Enhanced Life $150,00050-99",64.2,82.2,106.7,66.099999999999994,86.1,112.6,70,90,118.5,"X","X","X"]
[]
[null,null,null,"List_RateTable_VOLHMO","ALL PLANS"]
[null,null,null,"Region 1",41,64.5,100.5,"X","X","X","X","X","X","X","X","X"]
[null,null,null,"Region 2",39,61.5,95.5,"X","X","X","X","X","X","X","X","X"]