Spreadsheet: 878653d1725890883-indirect-address-ref-error-indirect-workbook
Sheet: TY SBCs

 | Current |  |  |  |  |  | Renewal |  |  |  |  |  | Option 2 |  |  |  |  |  | Option 3 |  |  |  |  |  | Option 4 |  |  |  |  |  | Option 5
Plan Nickname | 1 |  | 2 |  | 3 |  | 1 |  | 2 |  | 3 |  | 1 |  | 2 |  | 3 |  | 1 |  | 2 |  | 3 |  | 1 |  | 2 |  | 3 |  | 1 |  | 2 |  | 3
Category | Fruit |  | Fruit |  | Fruit |  | Fruit |  | Fruit |  | Fruit |  | UnitedHealthcare |  | UnitedHealthcare |  | UnitedHealthcare |  | HealthPartners |  | HealthPartners |  | HealthPartners |  | Blue Cross Blue Shield of Minnesota |  | Blue Cross Blue Shield of Minnesota |  | Blue Cross Blue Shield of Minnesota |  | [NAME] |  | [NAME] |  | [NAME]
Plan Name | Apple |  | [NAME] |  | Kiwi |  | Apple |  | [NAME] |  | Kiwi |  | UHC Choice Plus Gold 1000-7 RX Copay - CU9N (CU9N-K35S) |  | UHC Choice Plus HSA Gold 2900-1 - DG64 (DG64-E83S) |  | UHC Choice Plus HSA Silver 4500-1 - DG6V (DG6V-K35S) |  | 600-50 Gold SE Open Access |  | 2400-100 HSA Non-Embedded Gold SE Open Access |  | 4500-100 HSA Non-Embedded Silver SE Open Access |  | BlueAccess Gold $500 Plan 635 |  | BlueAccess HSA Gold $2600 Plan 653 |  | BlueAccess HSA Silver $4600 Plan 642 |  | [NAME] MN 500-30/60-30% Gold |  | [NAME] MN 2600-0% HSA + Rx Copays Gold |  | [NAME] MN 4750-0% HSA Silver + Rx Copays
 |  |  |  |  |  |  |  |  |  |  |  |  | PPO |  | PPO / HDHP / HSA |  | PPO / HDHP / HSA |  | PPO |  | PPO / HDHP / HSA |  | PPO / HDHP / HSA |  | PPO |  | PPO / HDHP / HSA |  | PPO / HDHP / HSA |  | PPO |  | PPO / HDHP / HSA |  | PPO / HDHP / HSA
 |  |  |  |  |  |  |  |  |  |  |  |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured |  | Fully Insured
 |  |  |  |  |  |  |  |  |  |  |  |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | -
 |  |  |  |  |  |  |  |  |  |  |  |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | - |  | -
 |  |  |  |  |  |  |  |  |  |  |  |  | CHOICE PLUS POS |  | CHOICE PLUS POS |  | CHOICE PLUS POS |  | OPEN ACCESS |  | OPEN ACCESS |  | OPEN ACCESS |  | AWARE |  | AWARE |  | AWARE |  | CHOICE PASSPORT |  | CHOICE PASSPORT |  | CHOICE PASSPORT
 |  |  |  |  |  |  |  |  |  |  |  |  | Gold |  | Gold |  | Silver |  | Gold |  | Gold |  | Silver |  | Gold |  | Gold |  | Silver |  | Gold |  | Gold |  | Silver
 |  |  |  |  |  |  |  |  |  |  |  |  | No |  | No |  | No |  | No |  | No |  | No |  | No |  | No |  | No |  | No |  | No |  | No
 |  |  |  |  |  |  |  |  |  |  |  |  | $1,000 |  | $2,900 |  | $4,500 |  | $600 |  | $2,400 |  | $4,500 |  | $500 |  | $2,600 |  | $4,600 |  | $500 |  | $2,600 |  | $4,750
 |  |  |  |  |  |  |  |  |  |  |  |  | $2,000 |  | $5,800 |  | $9,000 |  | $1,800 |  | $4,800 |  | $9,000 |  | $1,000 |  | $5,200 |  | $9,200 |  | $1,500 |  | $5,200 |  | $9,500
 |  |  |  |  |  |  |  |  |  |  |  |  | Embedded |  | Non-embedded |  | Embedded |  | Embedded |  | Non-embedded |  | Non-embedded |  | Embedded |  | Non-embedded |  | Non-embedded |  | Embedded |  | Non-embedded |  | Embedded
 |  |  |  |  |  |  |  |  |  |  |  |  | 30% / Tier-2: 0% |  | 0% |  | 0% |  | 30% |  | 0% |  | 0% |  | 30% |  | 0% |  | 0% |  | 30% |  | 0% |  | 0%
 |  |  |  |  |  |  |  |  |  |  |  |  | $6,900 |  | $2,900 |  | $7,300 |  | $6,250 |  | $2,400 |  | $4,500 |  | $7,000 |  | $2,600 |  | $4,600 |  | $6,750 |  | $3,300 |  | $6,000
 |  |  |  |  |  |  |  |  |  |  |  |  | $13,800 |  | $5,800 |  | $14,600 |  | $12,500 |  | $4,800 |  | $9,000 |  | $14,000 |  | $5,200 |  | $9,200 |  | $13,500 |  | $6,600 |  | $12,000
 |  |  |  |  |  |  |  |  |  |  |  |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | $15 |  | 0% after deductible |  | $20 after deductible |  | $50 |  | 0% after deductible |  | 0% after deductible |  | $35 |  | 0% after deductible |  | 0% after deductible |  | $30 |  | 0% after deductible |  | 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | $50 / Tier-2: $100 |  | 0% after deductible |  | $50 after deductible |  | $50 |  | 0% after deductible |  | 0% after deductible |  | $70 |  | 0% after deductible |  | 0% after deductible |  | $60 |  | 0% after deductible |  | 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | $50 |  | 0% after deductible |  | $50 after deductible |  | $50 |  | 0% after deductible |  | 0% after deductible |  | $70 |  | 0% after deductible |  | 0% after deductible |  | $30 |  | 0% after deductible |  | 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | $300 plus 30% after deductible |  | 0% after deductible |  | $250 after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | 30% after deductible / 30% after deductible |  | 0% after deductible / 0% after deductible |  | 0% after deductible / 0% after deductible |  | 30% after deductible / 30% after deductible |  | 0% after deductible / 0% after deductible |  | 0% after deductible / 0% after deductible |  | 30% after deductible / 30% after deductible |  | 0% after deductible / 0% after deductible |  | 0% after deductible / 0% after deductible |  | 30% after deductible / 30% after deductible |  | 0% after deductible / 0% after deductible |  | 0% after deductible / 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible |  | 30% after deductible |  | 0% after deductible |  | 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Covered |  | Covered |  | Covered
 |  |  |  |  |  |  |  |  |  |  |  |  | $0 |  | Included in Medical |  | Included in Medical |  | Included in Medical |  | Included in Medical |  | Included in Medical |  | $0 |  | Included in Medical |  | Included in Medical |  | $0 |  | Included in Medical |  | Included in Medical
 |  |  |  |  |  |  |  |  |  |  |  |  | $0 |  | Included in Medical |  | Included in Medical |  | Included in Medical |  | Included in Medical |  | Included in Medical |  | $0 |  | Included in Medical |  | Included in Medical |  | $0 |  | Included in Medical |  | Included in Medical
 |  |  |  |  |  |  |  |  |  |  |  |  | $10 per script / $40 per script / $125 per script / $300 per script / $10-$500 per script |  | 0% after deductible / 0% after deductible / 0% after deductible / 0% after deductible / 0% after deductible |  | $10 per script after deductible / $40 per script after deductible / $125 per script after deductible / $300 per script after deductible / $10-$500 per script after deductible |  | $5-$25 / $150 / $60 / $150 / 20% |  | 0% after deductible / Not Covered / 0% after deductible / Not Covered / 0% after deductible |  | 0% after deductible / Not Covered / 0% after deductible / Not Covered / 0% after deductible |  | $20 per script / Not Applicable / $75 per script / $150 per script / 30% |  | 0% after deductible / Not Applicable / 0% after deductible / 0% after deductible / 0% after deductible |  | 0% after deductible / Not Applicable / 0% after deductible / 0% after deductible / 0% after deductible |  | $15 per script / Not Applicable / $60 per script / $150 per script / $350 per script |  | 0% after deductible / Not Applicable / $60 per script after deductible / $150 per script after deductible / $250 per script after deductible |  | 0% after deductible / Not Applicable / $75 per script after deductible / $160 per script after deductible / $500 per script after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | $10 per script |  | 0% after deductible |  | $10 per script after deductible |  | $5-$25 |  | 0% after deductible |  | 0% after deductible |  | $20 per script |  | 0% after deductible |  | 0% after deductible |  | $15 per script |  | 0% after deductible |  | 0% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | $40 per script |  | 0% after deductible |  | $40 per script after deductible |  | $150 |  | Not Covered |  | Not Covered |  | Not Applicable |  | Not Applicable |  | Not Applicable |  | Not Applicable |  | Not Applicable |  | Not Applicable
 |  |  |  |  |  |  |  |  |  |  |  |  | $125 per script |  | 0% after deductible |  | $125 per script after deductible |  | $60 |  | 0% after deductible |  | 0% after deductible |  | $75 per script |  | 0% after deductible |  | 0% after deductible |  | $60 per script |  | $60 per script after deductible |  | $75 per script after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | $300 per script |  | 0% after deductible |  | $300 per script after deductible |  | $150 |  | Not Covered |  | Not Covered |  | $150 per script |  | 0% after deductible |  | 0% after deductible |  | $150 per script |  | $150 per script after deductible |  | $160 per script after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | $10-$500 per script |  | 0% after deductible |  | $10-$500 per script after deductible |  | 20% |  | 0% after deductible |  | 0% after deductible |  | 30% |  | 0% after deductible |  | 0% after deductible |  | $350 per script |  | $250 per script after deductible |  | $500 per script after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | Not Covered |  | Not Covered |  | Not Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered
 |  |  |  |  |  |  |  |  |  |  |  |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered
 |  |  |  |  |  |  |  |  |  |  |  |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered
 |  |  |  |  |  |  |  |  |  |  |  |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered |  | Covered
 |  |  |  |  |  |  |  |  |  |  |  |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered |  | Not Covered
 |  |  |  |  |  |  |  |  |  |  |  |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000 |  | $10,000
 |  |  |  |  |  |  |  |  |  |  |  |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000 |  | $20,000
 |  |  |  |  |  |  |  |  |  |  |  |  | 50% |  | 50% |  | 50% |  | 50% |  | 50% |  | 50% |  | 50% |  | 50% |  | 50% |  | 50% |  | 50% |  | 50%
 |  |  |  |  |  |  |  |  |  |  |  |  | $20,000 |  | $20,000 |  | $20,000 |  | $30,000 |  | $30,000 |  | $30,000 |  | $30,000 |  | $30,000 |  | $30,000 |  | Not Covered |  | Not Covered |  | Not Covered
 |  |  |  |  |  |  |  |  |  |  |  |  | $40,000 |  | $40,000 |  | $40,000 |  | $60,000 |  | $60,000 |  | $60,000 |  | $60,000 |  | $60,000 |  | $60,000 |  | Not Covered |  | Not Covered |  | Not Covered
 |  |  |  |  |  |  |  |  |  |  |  |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible |  | 50% after deductible
 |  |  |  |  |  |  |  |  |  |  |  |  | 3 |  | 8 |  | 0 |  | 3 |  | 8 |  | 0 |  | 3 |  | 8 |  | 0 |  | 3 |  | 8 |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  | 0 |  | 0 |  | 0 |  | 0 |  | 0 |  | 0 |  | 0 |  | 0 |  | 0 |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | 1 |  | 0 |  | 0 |  | 1 |  | 0 |  | 0 |  | 1 |  | 0 |  | 0 |  | 1 |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | 3 |  | 1 |  | 0 |  | 3 |  | 1 |  | 0 |  | 3 |  | 1 |  | 0 |  | 3 |  | 1
 |  |  |  |  |  |  |  |  |  |  |  |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated |  | Age Rated
 |  |  |  |  |  |  |  |  |  |  |  |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates |  | See ACA Age EE Contrib tabs for member & dependent age rates
 |  |  |  |  |  |  |  |  |  |  |  |  | 1768.78 |  | 12928.04 |  | 1826.97 |  | 1686.28 |  | 11881.78 |  | 1655.75 |  | 1669.2 |  | 11948.63 |  | 1664.97 |  | 1625.73 |  | 12250.81 |  | 1774.16