{"text_format":"1","workbook":"xlsx","n_sheets":4,"sheets":["Adult-Family Benefits 1","Adult-Family Cost-Sharing 1","Adult-Family Benefits 2","Adult-Family Cost-Sharing 2"],"not_rendered":{"charts":0,"images":0,"macros":0,"external_links":1,"defined_names":19,"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":"Adult-Family Benefits 1","index":0,"n_rows":90,"n_cols":15,"rows_kept":90,"cut":false,"hidden":false,"merged":[[65,0,65,1],[6,0,6,3],[6,4,6,7],[6,8,6,12],[6,13,6,14],[58,0,58,3],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[77,0,77,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[73,0,73,1],[74,0,74,1],[75,0,75,1],[76,0,76,1],[89,0,89,1],[78,0,78,1],[79,0,79,1],[80,0,80,1],[81,0,81,1],[82,0,82,1],[83,0,83,1],[84,0,84,1],[85,0,85,1],[86,0,86,1],[87,0,87,1],[88,0,88,1]]}
["2024 Dental Products Benefit & Cost-Sharing Template"]
["HIOS Issuer ID"]
["Issuer State"]
["Market Coverage"]
["Dental Only Plan"]
["TIN"]
["Plan Identifiers",null,null,null,null,null,null,null,"Geographic Coverage",null,null,null,null,"Benefit Information"]
["HIOS Plan ID\n(Standard Component)","Plan Marketing Name","Network Name","Plan Type","Waiting Periods for Dental Services?","Dental Out-of-Network Coverage?","Is a Referral Required for Dental Specialists?","Specialist(s) Requiring a Referral","Out of Country Dental Coverage","Out of Country Dental Coverage Description","Out of Service Area Dental Coverage","Out of Service Area Dental Coverage Description"," National Dental Network","Dental Benefit Limits","Dental Benefit Exclusions"]
[null,null,null,null,null,null,null,"",""]
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["Benefit Information"]
["Benefits",null,"EHB?","Is this Benefit Covered?"]
["Dental Check-Up - Child"]
["Basic Dental Care - Child"]
["Orthodontia - Child"]
["Major Dental Care - Child"]
["Cosmetic Orthodontia - Child",null,"No"]
["Office Visit - Adult"]
["Oral Evaluation - Adult"]
["Complete Set of X-Rays - Adult"]
["Prophylaxis - Adult"]
["Topical Fluoride - Adult"]
["Polishing - Adult"]
["Sealant (per tooth) - Adult"]
["Spacers - Adult"]
["Simple Extraction - Adult"]
["Fillings - Adult"]
["Single Restoration Crowns - Adult"]
["Pulp Cap - Adult"]
["Root Canal - Adult"]
["Bonding - Adult"]
["Scaling & Planing - Adult"]
["Gingivectomy or Gingivoplasty - Adult"]
["Gum Surgery - Adult"]
["Tissue Grafting - Adult"]
["Routine Braces - Adult"]
["Partial Dentures - Adult"]
["Complete Dentures - Adult"]
["Dental Implants - Adult"]
["Bridges - Adult"]
["Veneers - Adult"]
["TMJ - Adult"]

{"sheet":"Adult-Family Cost-Sharing 1","index":1,"n_rows":3,"n_cols":140,"rows_kept":3,"cut":false,"hidden":false,"merged":[[1,38,1,39],[0,20,0,23],[0,24,0,27],[1,20,1,21],[1,22,1,23],[1,24,1,25],[1,26,1,27],[1,28,1,29],[1,30,1,31],[1,32,1,33],[1,34,1,35],[1,36,1,37],[1,62,1,63],[1,40,1,41],[1,42,1,43],[1,44,1,45],[1,46,1,47],[1,48,1,49],[1,50,1,51],[1,52,1,53],[1,54,1,55],[1,56,1,57],[1,58,1,59],[1,60,1,61],[1,86,1,87],[1,64,1,65],[1,66,1,67],[1,68,1,69],[1,70,1,71],[1,72,1,73],[1,74,1,75],[1,76,1,77],[1,78,1,79],[1,80,1,81],[1,82,1,83],[1,84,1,85],[1,110,1,111],[1,88,1,89],[1,90,1,91],[1,92,1,93],[1,94,1,95],[1,96,1,97],[1,98,1,99],[1,100,1,101],[1,102,1,103],[1,104,1,105],[1,106,1,107],[1,108,1,109],[1,134,1,135],[1,112,1,113],[1,114,1,115],[1,116,1,117],[1,118,1,119],[1,120,1,121],[1,122,1,123],[0,80,0,83],[1,136,1,137],[1,138,1,139],[0,28,0,31],[0,32,0,35],[0,36,0,39],[0,40,0,43],[0,44,0,47],[0,48,0,51],[0,52,0,55],[0,56,0,59],[1,124,1,125],[1,126,1,127],[1,128,1,129],[1,130,1,131],[1,132,1,133],[0,60,0,63],[0,64,0,67],[0,68,0,71],[0,72,0,75],[0,76,0,79],[0,132,0,135],[0,136,0,139],[1,0,1,19],[0,0,0,19],[0,108,0,111],[0,112,0,115],[0,116,0,119],[0,120,0,123],[0,124,0,127],[0,128,0,131],[0,84,0,87],[0,88,0,91],[0,92,0,95],[0,96,0,99],[0,100,0,103],[0,104,0,107]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Dental Check-Up - Child",null,null,null,"Basic Dental Care - Child",null,null,null,"Orthodontia - Child",null,null,null,"Major Dental Care - Child",null,null,null,"Cosmetic Orthodontia - Child",null,null,null,"Office Visit - Adult",null,null,null,"Oral Evaluation - Adult",null,null,null,"Complete Set of X-Rays - Adult",null,null,null,"Prophylaxis - Adult",null,null,null,"Topical Fluoride - Adult",null,null,null,"Polishing - Adult",null,null,null,"Sealant (per tooth) - Adult",null,null,null,"Spacers - Adult",null,null,null,"Simple Extraction - Adult",null,null,null,"Fillings - Adult",null,null,null,"Single Restoration Crowns - Adult",null,null,null,"Pulp Cap - Adult",null,null,null,"Root Canal - Adult",null,null,null,"Bonding - Adult",null,null,null,"Scaling & Planing - Adult",null,null,null,"Gingivectomy or Gingivoplasty - Adult",null,null,null,"Gum Surgery - Adult",null,null,null,"Tissue Grafting - Adult",null,null,null,"Routine Braces - Adult",null,null,null,"Partial Dentures - Adult",null,null,null,"Complete Dentures - Adult",null,null,null,"Dental Implants - Adult",null,null,null,"Bridges - Adult",null,null,null,"Veneers - Adult",null,null,null,"TMJ - Adult"]
["Plan Cost Sharing Attributes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance"]
["HIOS Plan ID* \n(Standard Component + Variant)","Plan Variant Marketing Name","Annual Dental Benefit Maximum","Lifetime Dental Benefit Maximum","INN Dental Deductible:  Individual Child","INN Dental Deductible:\n2+ Members - Children","INN Dental MOOP: Individual Child","INN Dental MOOP: 2+ Members - Children","INN Dental Deductible: Individual Adult","INN Dental Deductible:\n2+ Members - Adult","INN Dental MOOP: Individual Adult","INN Dental MOOP: 2+ Members - Adult","OON Dental Deductible: Individual Child","OON Dental Deductible: 2+ Members - Children","OON Dental MOOP: Individual Child","OON Dental MOOP: 2+ Members - Children","OON Dental Deductible: Individual Adult","OON Dental Deductible: 2+ Members - Adult","OON Dental MOOP: Individual Adult","OON Dental MOOP: 2+ Members - Adult","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network"]

{"sheet":"Adult-Family Benefits 2","index":2,"n_rows":90,"n_cols":15,"rows_kept":90,"cut":false,"hidden":false,"merged":[[65,0,65,1],[6,0,6,3],[6,4,6,7],[6,8,6,12],[6,13,6,14],[58,0,58,3],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[77,0,77,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[73,0,73,1],[74,0,74,1],[75,0,75,1],[76,0,76,1],[89,0,89,1],[78,0,78,1],[79,0,79,1],[80,0,80,1],[81,0,81,1],[82,0,82,1],[83,0,83,1],[84,0,84,1],[85,0,85,1],[86,0,86,1],[87,0,87,1],[88,0,88,1]]}
["2024 Dental Products Benefit & Cost-Sharing Template"]
["HIOS Issuer ID"]
["Issuer State"]
["Market Coverage"]
["Dental Only Plan"]
["TIN"]
["Plan Identifiers",null,null,null,null,null,null,null,"Geographic Coverage",null,null,null,null,"Benefit Information"]
["HIOS Plan ID\n(Standard Component)","Plan Marketing Name","Network Name","Plan Type","Waiting Periods for Dental Services?","Dental Out-of-Network Coverage?","Is a Referral Required for Dental Specialists?","Specialist(s) Requiring a Referral","Out of Country Dental Coverage","Out of Country Dental Coverage Description","Out of Service Area Dental Coverage","Out of Service Area Dental Coverage Description"," National Dental Network","Dental Benefit Limits","Dental Benefit Exclusions"]
[null,null,null,null,null,null,null,"",""]
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["Benefit Information"]
["Benefits",null,"EHB?","Is this Benefit Covered?"]
["Dental Check-Up - Child"]
["Basic Dental Care - Child"]
["Orthodontia - Child"]
["Major Dental Care - Child"]
["Cosmetic Orthodontia - Child",null,"No"]
["Office Visit - Adult"]
["Oral Evaluation - Adult"]
["Complete Set of X-Rays - Adult"]
["Prophylaxis - Adult"]
["Topical Fluoride - Adult"]
["Polishing - Adult"]
["Sealant (per tooth) - Adult"]
["Spacers - Adult"]
["Simple Extraction - Adult"]
["Fillings - Adult"]
["Single Restoration Crowns - Adult"]
["Pulp Cap - Adult"]
["Root Canal - Adult"]
["Bonding - Adult"]
["Scaling & Planing - Adult"]
["Gingivectomy or Gingivoplasty - Adult"]
["Gum Surgery - Adult"]
["Tissue Grafting - Adult"]
["Routine Braces - Adult"]
["Partial Dentures - Adult"]
["Complete Dentures - Adult"]
["Dental Implants - Adult"]
["Bridges - Adult"]
["Veneers - Adult"]
["TMJ - Adult"]

{"sheet":"Adult-Family Cost-Sharing 2","index":3,"n_rows":3,"n_cols":140,"rows_kept":3,"cut":false,"hidden":false,"merged":[[0,36,0,39],[0,0,0,19],[0,20,0,23],[0,24,0,27],[0,28,0,31],[0,32,0,35],[0,84,0,87],[0,40,0,43],[0,44,0,47],[0,48,0,51],[0,52,0,55],[0,56,0,59],[0,60,0,63],[0,64,0,67],[0,68,0,71],[0,72,0,75],[0,76,0,79],[0,80,0,83],[0,132,0,135],[0,88,0,91],[0,92,0,95],[0,96,0,99],[0,100,0,103],[0,104,0,107],[0,108,0,111],[1,46,1,47],[0,136,0,139],[1,0,1,19],[1,20,1,21],[1,22,1,23],[1,24,1,25],[1,26,1,27],[1,28,1,29],[1,30,1,31],[1,32,1,33],[1,34,1,35],[0,112,0,115],[0,116,0,119],[0,120,0,123],[0,124,0,127],[0,128,0,131],[1,36,1,37],[1,38,1,39],[1,40,1,41],[1,42,1,43],[1,44,1,45],[1,70,1,71],[1,48,1,49],[1,50,1,51],[1,52,1,53],[1,54,1,55],[1,56,1,57],[1,58,1,59],[1,60,1,61],[1,62,1,63],[1,64,1,65],[1,66,1,67],[1,68,1,69],[1,94,1,95],[1,72,1,73],[1,74,1,75],[1,76,1,77],[1,78,1,79],[1,80,1,81],[1,82,1,83],[1,84,1,85],[1,86,1,87],[1,88,1,89],[1,90,1,91],[1,92,1,93],[1,118,1,119],[1,96,1,97],[1,98,1,99],[1,100,1,101],[1,102,1,103],[1,104,1,105],[1,106,1,107],[1,108,1,109],[1,110,1,111],[1,112,1,113],[1,114,1,115],[1,116,1,117],[1,132,1,133],[1,134,1,135],[1,136,1,137],[1,138,1,139],[1,120,1,121],[1,122,1,123],[1,124,1,125],[1,126,1,127],[1,128,1,129],[1,130,1,131]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Dental Check-Up - Child",null,null,null,"Basic Dental Care - Child",null,null,null,"Orthodontia - Child",null,null,null,"Major Dental Care - Child",null,null,null,"Cosmetic Orthodontia - Child",null,null,null,"Office Visit - Adult",null,null,null,"Oral Evaluation - Adult",null,null,null,"Complete Set of X-Rays - Adult",null,null,null,"Prophylaxis - Adult",null,null,null,"Topical Fluoride - Adult",null,null,null,"Polishing - Adult",null,null,null,"Sealant (per tooth) - Adult",null,null,null,"Spacers - Adult",null,null,null,"Simple Extraction - Adult",null,null,null,"Fillings - Adult",null,null,null,"Single Restoration Crowns - Adult",null,null,null,"Pulp Cap - Adult",null,null,null,"Root Canal - Adult",null,null,null,"Bonding - Adult",null,null,null,"Scaling & Planing - Adult",null,null,null,"Gingivectomy or Gingivoplasty - Adult",null,null,null,"Gum Surgery - Adult",null,null,null,"Tissue Grafting - Adult",null,null,null,"Routine Braces - Adult",null,null,null,"Partial Dentures - Adult",null,null,null,"Complete Dentures - Adult",null,null,null,"Dental Implants - Adult",null,null,null,"Bridges - Adult",null,null,null,"Veneers - Adult",null,null,null,"TMJ - Adult"]
["Plan Cost Sharing Attributes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance",null,"Copay",null,"Coinsurance"]
["HIOS Plan ID* \n(Standard Component + Variant)","Plan Variant Marketing Name","Annual Dental Benefit Maximum","Lifetime Dental Benefit Maximum","INN Dental Deductible:  Individual Child","INN Dental Deductible:\n2+ Members - Children","INN Dental MOOP: Individual Child","INN Dental MOOP: 2+ Members - Children","INN Dental Deductible: Individual Adult","INN Dental Deductible:\n2+ Members - Adult","INN Dental MOOP: Individual Adult","INN Dental MOOP: 2+ Members - Adult","OON Dental Deductible: Individual Child","OON Dental Deductible: 2+ Members - Children","OON Dental MOOP: Individual Child","OON Dental MOOP: 2+ Members - Children","OON Dental Deductible: Individual Adult","OON Dental Deductible: 2+ Members - Adult","OON Dental MOOP: Individual Adult","OON Dental MOOP: 2+ Members - Adult","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network","In-Network","Out-of-Network"]