{"text_format":"3","workbook":"xlsx","n_sheets":3,"sheets":["$500 Deductible","$1000 Deductible","Prescription Drugs"],"not_rendered":{"defined_names":4},"read":"whole","date_system":"1900"}

{"sheet":"$500 Deductible","index":0,"n_rows":58,"n_cols":5,"rows_kept":58,"merged":[[0,0,0,4],[1,0,1,4],[2,1,2,4],[5,1,5,2],[8,1,8,2],[50,1,50,2],[52,0,52,4],[53,0,53,4],[54,0,54,4],[55,0,55,4],[57,0,57,4]]}
["PPO PLAN DESIGN COMPARISON - $500 Deductible Option"]
["Please only note your deviations from the requested plan design.  If you are able to match the requested plan design, then the space should be left blank."]
["Plan changes from 2017 to current:","None"]
["The following benefits are the same for BCBST Network S and P"]
["Benefit Category","Requested In-Network","Requested Out-of-Network (1)","Quoting Vendor In-Network","Quoting Vendor Out-of-Network"]
["Annual Deductible","In and Out-of-Network Deductibles do not cross accumulate"]
["Individual",{"v":500,"d":"$500"},{"v":1000,"d":"$1,000"}]
["Family",{"v":1000,"d":"$1,000"},{"v":2000,"d":"$2,000"}]
["Annual Out-of-Pocket Maximum\n(Includes deductible & coinsurance)","In and Out-of-Network Maximums do not cross accumulate"]
["Individual",{"v":2500,"d":"$2,500"},{"v":7500,"d":"$7,500"}]
["Family",{"v":5000,"d":"$5,000"},{"v":15000,"d":"$15,000"}]
["Lifetime Benefit Maximum","Unlimited","Unlimited"]
["Practitioner Office Services"]
["Office Visits","80% after deductible","60% after deductible"]
["Vision","Routine eye exams & materials \nare not covered  ","Routine eye exams & materials \nare not covered  "]
["Allergy Injections","80% after deductible","60% after deductible"]
["Routine Diagnostic Lab, X-Ray, & Injections","80% after deductible","60% after deductible"]
["Non-Routine Diagnostic Services (2)\n(CAT scans, MRIs, PET scans, nuclear medicine)","80% after deductible","60% after deductible"]
["Preventive Health Care Services"]
["Well Child Care",{"v":1,"d":"100%"},"60% after deductible"]
["Annual Well Woman Exam",{"v":1,"d":"100%"},"60% after deductible"]
["Annual Mammography Screening",{"v":1,"d":"100%"},"60% after deductible"]
["Annual Cervical Cancer Screening",{"v":1,"d":"100%"},"60% after deductible"]
["Prostate Cancer Screening",{"v":1,"d":"100%"},"60% after deductible"]
["Immunizations ",{"v":1,"d":"100%"},"60% after deductible"]
["Screening flexible sigmoidoscopy and screening colonoscopy",{"v":1,"d":"100%"},"60% after deductible"]
["Services Received at a Facility (professional & facility charges)"]
["Inpatient Services (2)","80% after deductible","60% after deductible"]
["Outpatient Surgery \n(invasive diagnostic procedures such as colonoscopy, sigmoidoscopy, and endoscopy)","80% after deductible","60% after deductible"]
["Routine Diagnostic Services-Outpatient","80% after deductible","60% after deductible"]
["Non-Routine Diagnostic Services-Outpatient (2)\n(CAT scans, MRIs, PET scans, nuclear medicine)","80% after deductible","60% after deductible"]
["Maternity Care","80% after deductible","60% after deductible"]
["Emergency Care Services","$150 ER copay","$150 ER copay"]
["Emergency Care \nNon-Routine Diagnostics\n(CAT scans, MRIs, nuclear medicine)","80% after deductible","80% after deductible"]
["Urgent Care","80% after deductible\n","60% after deductible\n"]
["Bariatric Surgery for Morbid Obesity \n(must be medically appropriate)","80% after deductible","60% after deductible"]
["Organ Transplant (3)","80% of TMAC after deductible (4)","60% of TMAC after deductible (4)"]
["Medical Equipment"]
["Durable Medical Equipment","80% after deductible","60% after deductible"]
["Prosthetic & Orthotic Appliances","80% after deductible","60% after deductible"]
["Therapeutic Services"]
["Therapy\n(includes physical, speech & occupational) ","80% after deductible\nas medically necessary; PA required\n","60% after deductible"]
["Chiropractics / Manipulative Therapy","80% after deductible - limited to 20 visits per calendar year","60% after deductible - limited to 20 visits per calendar year"]
["Skilled Nursing Facility & Rehabilitative Facility Services (2)\n(limited to 60 days combined)","80% after deductible","60% after deductible"]
["Home Health Services (2)\n(limited to 60 visits per year)","80% after deductible","60% after deductible"]
["Hospice Services",{"v":1,"d":"100%"},"60% after deductible"]
["Ambulance Services","80% after deductible","80% after deductible"]
["Behavioral Health Benefits (2)\nMental Health / Substance Abuse Treatment "]
["Inpatient \n","80% after deductible","60% after deductible"]
["Outpatient \n","80% after deductible","60% after deductible"]
["Pre-Existing Condition Limitation","N/A as of 1/01/14"]
[]
["Currently, the City of Knoxville employee has the choice between the BlueCross BlueShield of TN Networks S & P.\n"]
["1)  Out-of-network benefit payment based on BlueCross BlueShield of TN maximum allowable charge.  Member is responsible for paying any amount exceeding the maximum allowable charge."]
["2) Services require prior authorization.  When using network providers outside TN and all out-of-network providers, benefits will be reduced to 50% if prior authorization is not obtained and services are medically necessary.  If services are not medically necessary, then no benefit will be provided."]
["3)  Network providers not in BlueCross BlueShield of TN transplant network include network providers in TN and BlueCard PPO providers outside of TN.  The benefit is 80% of Transplant Maximum Allowable Charge (TMAC) after deductible.  Amounts over TMAC do not apply to the out-of-pocket maximum and are not covered.  This applies to all transplants except for kidney transplants where it is 80% after deductible."]
[]
[" "]

{"sheet":"$1000 Deductible","index":1,"n_rows":58,"n_cols":5,"rows_kept":58,"merged":[[0,0,0,4],[1,0,1,4],[2,1,2,4],[5,1,5,2],[8,1,8,2],[50,1,50,2],[52,0,52,4],[53,0,53,4],[54,0,54,4],[55,0,55,4],[57,0,57,4]]}
["PPO PLAN DESIGN COMPARISON - $1000 Deductible Option"]
["Please only note your deviations from the requested plan design.  If you are able to match the requested plan design, then the space should be left blank."]
["Plan changes from 2017 to current:","None"]
["The following benefits are the same for BCBST Network S and P"]
["Benefit Category","Requested In-Network","Requested Out-of-Network (1)","Quoting Vendor In-Network","Quoting Vendor Out-of-Network"]
["Annual Deductible","In and Out-of-Network Deductibles do not cross accumulate"]
["Individual",{"v":1000,"d":"$1,000"},{"v":2000,"d":"$2,000"}]
["Family",{"v":2000,"d":"$2,000"},{"v":4000,"d":"$4,000"}]
["Annual Out-of-Pocket Maximum\n(Includes deductible & coinsurance)","In and Out-of-Network Maximums do not cross accumulate"]
["Individual",{"v":2500,"d":"$2,500"},{"v":7500,"d":"$7,500"}]
["Family",{"v":5000,"d":"$5,000"},{"v":15000,"d":"$15,000"}]
["Lifetime Benefit Maximum","Unlimited","Unlimited"]
["Practitioner Office Services"]
["Office Visits","80% after deductible","60% after deductible"]
["Vision","Routine eye exams & materials \nare not covered  ","Routine eye exams & materials \nare not covered  "]
["Allergy Injections","80% after deductible","60% after deductible"]
["Routine Diagnostic Lab, X-Ray, & Injections","80% after deductible","60% after deductible"]
["Non-Routine Diagnostic Services (2)\n(CAT scans, MRIs, PET scans, nuclear medicine)","80% after deductible","60% after deductible"]
["Preventive Health Care Services"]
["Well Child Care",{"v":1,"d":"100%"},"60% after deductible"]
["Annual Well Woman Exam",{"v":1,"d":"100%"},"60% after deductible"]
["Annual Mammography Screening",{"v":1,"d":"100%"},"60% after deductible"]
["Annual Cervical Cancer Screening",{"v":1,"d":"100%"},"60% after deductible"]
["Prostate Cancer Screening",{"v":1,"d":"100%"},"60% after deductible"]
["Immunizations ",{"v":1,"d":"100%"},"60% after deductible"]
["Screening flexible sigmoidoscopy and screening colonoscopy",{"v":1,"d":"100%"},"60% after deductible"]
["Services Received at a Facility (professional & facility charges)"]
["Inpatient Services (2)","80% after deductible","60% after deductible"]
["Outpatient Surgery \n(invasive diagnostic procedures such as colonoscopy, sigmoidoscopy, and endoscopy)","80% after deductible","60% after deductible"]
["Routine Diagnostic Services-Outpatient","80% after deductible","60% after deductible"]
["Non-Routine Diagnostic Services-Outpatient (2)\n(CAT scans, MRIs, PET scans, nuclear medicine)","80% after deductible","60% after deductible"]
["Maternity Care","80% after deductible","60% after deductible"]
["Emergency Care Services","80% after deductible","60% after deductible"]
["Emergency Care \nNon-Routine Diagnostics\n(CAT scans, MRIs, nuclear medicine)","80% after deductible","80% after deductible"]
["Urgent Care","80% after deductible\n","60% after deductible\n"]
["Bariatric Surgery for Morbid Obesity \n(must be medically appropriate)","80% after deductible","60% after deductible"]
["Organ Transplant (3)","80% of TMAC after deductible (4)","60% of TMAC after deductible (4)"]
["Medical Equipment"]
["Durable Medical Equipment","80% after deductible","60% after deductible"]
["Prosthetic & Orthotic Appliances","80% after deductible","60% after deductible"]
["Therapeutic Services"]
["Therapy\n(includes physical, speech & occupational) ","80% after deductible\nas medically necessary; PA required\n","60% after deductible"]
["Chiropractics / Manipulative Therapy","80% after deductible - limited to 20 visits per calendar year","60% after deductible - limited to 20 visits per calendar year"]
["Skilled Nursing Facility & Rehabilitative Facility Services (2)\n(limited to 60 days combined)","80% after deductible","60% after deductible"]
["Home Health Services (2)\n(limited to 60 visits per year)","80% after deductible","60% after deductible"]
["Hospice Services",{"v":1,"d":"100%"},"60% after deductible"]
["Ambulance Services","80% after deductible","80% after deductible"]
["Behavioral Health Benefits\nMental Health / Substance Abuse Treatment "]
["Inpatient \n","80% after deductible","60% after deductible"]
["Outpatient \n","80% after deductible","60% after deductible"]
["Pre-Existing Condition Limitation","N/A as of 1/01/14"]
[]
["Currently, the City of Knoxville employee has the choice between the BlueCross BlueShield of TN Networks S & P.\n"]
["1)  Out-of-network benefit payment based on BlueCross BlueShield of TN maximum allowable charge.  Member is responsible for paying any amount exceeding the maximum allowable charge."]
["2) Services require prior authorization.  When using network providers outside TN and all out-of-network providers, benefits will be reduced to 50% if prior authorization is not obtained and services are medically necessary.  If services are not medically necessary, then no benefit will be provided."]
["3)  Network providers not in BlueCross BlueShield of TN transplant network include network providers in TN and BlueCard PPO providers outside of TN.  The benefit is 80% of Transplant Maximum Allowable Charge (TMAC) after deductible.  Amounts over TMAC do not apply to the out-of-pocket maximum and are not covered.  This applies to all transplants except for kidney transplants where it is 80% after deductible."]
[]
[" "]

{"sheet":"Prescription Drugs","index":2,"n_rows":9,"n_cols":7,"rows_kept":9,"merged":[[1,1,1,2],[1,3,1,4],[1,5,1,6]]}
[]
[null,"Retail\n(30 day supply)",null,"Mail Order\n(90 day supply)",null,"90 Days at Retail\n(90 day supply)"]
[null,"Preventive","All Other Drugs","Preventive","All Other Drugs","Preventive","All Other Drugs"]
["Level 1",{"v":0,"d":"$0.00"},{"v":5,"d":"$5.00"},{"v":0,"d":"$0.00"},{"$f":"+C4*2","v":{"v":10,"d":"$10.00"}},{"v":0,"d":"$0"},{"$f":"+C4*2.5","v":{"v":12.5,"d":"$12.50"}}]
["Level 2",{"v":5,"d":"$5.00"},{"v":10,"d":"$10.00"},{"$f":"+B5*2","v":{"v":10,"d":"$10.00"}},{"$f":"+C5*2","v":{"v":20,"d":"$20.00"}},{"$f":"+B5*2.5","v":{"v":12.5,"d":"$12.50"}},{"$f":"+C5*2.5","v":{"v":25,"d":"$25.00"}}]
["Level 3",{"v":10,"d":"$10.00"},{"v":20,"d":"$20.00"},{"$f":"+B6*2","v":{"v":20,"d":"$20.00"}},{"$f":"+C6*2","v":{"v":40,"d":"$40.00"}},{"$f":"+B6*2.5","v":{"v":25,"d":"$25.00"}},{"$f":"+C6*2.5","v":{"v":50,"d":"$50.00"}}]
["Level 4",{"v":20,"d":"$20.00"},{"v":40,"d":"$40.00"},{"v":40,"d":"$40.00"},{"$f":"+C7*2","v":{"v":80,"d":"$80.00"}},{"v":50,"d":"$50.00"},{"$f":"+C7*2.5","v":{"v":100,"d":"$100.00"}}]
["Specialty*",{"v":40,"d":"$40.00"},{"v":80,"d":"$80.00"},"N/A","N/A","N/A","N/A"]
["* - Limited to a 30 day supply"]