Spreadsheet: 884863d1734130407-index-match-help-census-index
Sheet: Template

 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | DATA VALIDATION |  | Yes | No
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Medical Insurance |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 2 | 3 | 4 | 5 | 6 | 7
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Plan Number | VARIABLE | VARIABLE | Coverage Level | [NAME] | FAMILY Deduction | Monthly Rate | Health Ins. Deduction |  |  |  |  |  |  | Worker | Worker + Child(ren) | Worker + Partner | 2 Parent Family | Dep. | Other Coverage | Waive
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 |  |  | Worker + Partner | #N/A | #N/A | #N/A | #N/A |  | Plan | Enrollees |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Bi-Weekly Payroll Deductions: EMPLOYEES |  |  |  |  |  |  |  |  |  |  | Bi-Weekly Payroll Deductions: DEPENDENTS
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 |  |  | Dep. | 0 | 0 | 0 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 |  |  | Worker | #N/A | #N/A | #N/A | #N/A |  | Vision Insurance | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 5 |  |  | Worker + Partner | #N/A | #N/A | #N/A | #N/A |  | Dental Insurance | 0 |  |  |  |  |  |  |  |  | Monthly ER Contribution (Employees) | Monthly ER Contribution (Dependents) | 1 - HMO Silver Proactive |  | 2 - HMO Gold Proactive |  | 3 - PPO Silver Secure |  | 4 - |  | 5 - |  |  | 1 - HMO Silver Proactive |  | 2 - HMO Gold Proactive |  | 3 - PPO Silver Secure |  | 4 - |  | 5 -
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 5 |  |  | Dep. | 0 | 0 | 0 | 0 |  | Health Insurance | 9
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 6 | No |  | Worker | #N/A | #N/A | #N/A | #N/A |  |  |  |  |  |  |  |  |  |  | Age |  |  | Non-Tobacco | Tobacco | Non-Tobacco | Tobacco | Non-Tobacco | Tobacco | Non-Tobacco | Tobacco | Non-Tobacco | Tobacco |  | Non-Tobacco | Tobacco | Non-Tobacco | Tobacco | Non-Tobacco | Tobacco | Non-Tobacco | Tobacco | Non-Tobacco | Tobacco
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | #N/A | #N/A | #N/A | #N/A |  |  |  |  |  | Total Monthly Premium |  |  |  |  | 0 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | #N/A | #N/A | #N/A | #N/A |  | Dental Premium | Monthly Rate |  |  | Worker | Worker + Child(ren) | Worker + Partner | 2 Parent Family |  | 1 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 |  |  | Worker | #N/A | #N/A | #N/A | #N/A |  | Worker | 28.75 |  | Alt 1: NavHE4000 | 354.52 | 728.79 | 760.24 | 1125.08 |  | 2 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 |  |  | Worker | #N/A | #N/A | #N/A | #N/A |  | Worker + Child(ren) | 79.55 |  | Alt 2: NavE1500 | 389.67 | 805.77 | 840.75 | 1246.38 |  | 3 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 |  |  | 2 Parent Family | #N/A | #N/A | #N/A | #N/A |  | Worker + Partner | 57.49 |  | Alt 3: NavE1000 | 423.27 | 879.34 | 917.67 | 1362.25 |  | 4 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 |  |  | Dep. | 0 | 0 | 0 | 0 |  | 2 Parent Family | 109.55 |  | Alt 4: HP4000 | 383.95 | 793.25 | 827.64 | 1226.63 |  | 5 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 |  |  | Dep. | 0 | 0 | 0 | 0 |  | Dental Payroll | Payroll Ded. |  | Alt 5: TIAE200 | 507.32 | 1063.43 | 1110.16 | 1652.26 |  | 6 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 |  |  | Dep. |  |  | 0 | 0 |  | Worker | 6.63 |  | Alt 6: NavE01575 | 537.05 | 1128.54 | 1178.25 | 1754.83 |  | 7 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Worker + Child(ren) | 30.08 |  |  |  |  |  |  |  | 8 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Worker + Partner | 19.9 |  |  |  |  |  |  |  | 9 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 Parent Family | 43.92 |  |  | MONTHLY Payroll Deduction: Employee |  |  |  |  | 10 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Worker | Worker + Child(ren) | Worker + Partner | 2 Parent Family |  | 11 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Monthly Health Bill |  |  | #N/A | #N/A |  | Vision Premium | Monthly Rate |  | Alt 1: NavHE4000 | 154.52 | 528.79 | 560.24 | 925.0799999999999 |  | 12 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yearly Medical [NAME] |  |  | #N/A | #N/A |  | Worker | 6.04 |  | Alt 2: NavE1500 | 189.67 | 605.77 | 640.75 | 1046.38 |  | 13 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Worker + Child(ren) | 11.48 |  | Alt 3: NavE1000 | 223.27 | 679.34 | 717.67 | 1162.25 |  | 14 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Worker + Partner | 12.09 |  | Alt 4: HP4000 | 183.95 | 593.25 | 627.64 | 1026.63 |  | 15 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 Parent Family | 18.05 |  | Alt 5: TIAE200 | 307.32 | 863.4300000000001 | 910.1600000000001 | 1452.26 |  | 16 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Vision Payroll | Payroll Ded. |  | Alt 6: NavE01575 | 337.05 | 928.54 | 978.25 | 1554.83 |  | 17 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Plan Name |  |  | Coverage Level |  |  |  | Total Rate |  | Worker | 2.79 |  |  |  |  |  |  |  | 18 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Worker + Child(ren) | 5.3 |  |  | MONTHLY Payroll Deduction: Dependents |  |  |  |  | 19 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Worker + Partner | 5.58 |  |  | Worker | Worker + Child(ren) | Worker + Partner | 2 Parent Family |  | 20 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 Parent Family | 8.33 |  | Alt 1: NavHE4000 | 354.52 | 728.79 | 760.24 | 1125.08 |  | 21 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Alt 2: NavE1500 | 389.67 | 805.77 | 840.75 | 1246.38 |  | 22 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Alt 3: NavE1000 | 423.27 | 879.34 | 917.67 | 1362.25 |  | 23 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Alt 4: HP4000 | 383.95 | 793.25 | 827.64 | 1226.63 |  | 24 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Alt 5: TIAE200 | 507.32 | 1063.43 | 1110.16 | 1652.26 |  | 25 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Alt 6: NavE01575 | 537.05 | 1128.54 | 1178.25 | 1754.83 |  | 26 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 27 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 28 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 29 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 30 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 32 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 33 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 34 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 35 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 36 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 37 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 38 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 39 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 40 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 41 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 42 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 43 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 44 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 45 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 46 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 47 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 48 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 49 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 50 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 51 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 52 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 53 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 54 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 55 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 56 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 57 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 58 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 59 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 60 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 61 | 200 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 62 | 200 | 0
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 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 64 | 200 | 0