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{"sheet":"Detailed Comparison","index":0,"n_rows":104,"n_cols":4,"rows_kept":104,"merged":[[3,0,4,3],[102,0,102,3],[103,0,103,3]]}
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[]
[]
["Aetna Plan Comparison for Ramapo Indian Hills Regional H.S. District"]
[]
["Carrier","Aetna","Aetna","Aetna"]
["In-Network","Open Access 10","Open Access 15","NJ Educators Health Plan"]
["Deductible Individual","None","None","None"]
["Deductible Family","None","None","None"]
["Coinsurance",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Maximum Out of Pocket Individual*",{"v":400,"d":"$400"},{"v":400,"d":"$400"},{"v":500,"d":"$500"}]
["Maximum Out of Pocket Family*",{"v":1000,"d":"$1,000"},{"v":1000,"d":"$1,000"},{"v":1000,"d":"$1,000"}]
["Benefit Maximum","Unlimited","Unlimited","Unlimited"]
["Lifetime Maximum","Unlimited","Unlimited","Unlimited"]
["Primary Care Office Visit",{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":10,"d":"$10"}]
["Specialist Office Visit",{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"}]
["Maternity Visits","100% after copay(1st visit)","100% after copay(1st visit)","100% after copay(1st visit)"]
["Allergy Testing and Treatment",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Routine Physical",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Routine GYN Exams",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Routine PAP/Mammograms",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Prostate/Colorectal Screening",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Immunizations",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Well Child Exams",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Well Child Immunizations/Lead Screening",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Laboratory office",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Laboratory outpatient",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["X-Ray/Radiology Services Office",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["X-Ray/Radiology Services Outpatient",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Inpatient Hospital- Facility Fees",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Inpatient Hospital- Professional Fees",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Emergency Room",{"v":25,"d":"$25"},{"v":50,"d":"$50"},{"v":125,"d":"$125"}]
["Ambulance",{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"}]
["Outpatient Hospital- Facility Fees",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Outpatient Hospital- Professional Fees",{"v":100,"d":"$100"},{"v":100,"d":"$100"},{"v":1,"d":"100%"}]
["Ambulatory/Surgi-center",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Mental Health/Hospital",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Mental Health/Office",{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"}]
["Substance/Alcohol Abuse/Hospital",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Substance/Alcohol Abuse/Office",{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"}]
["Acupuncture",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Bariatric Surgery",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Diabetic Supplies",{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":1,"d":"100%"}]
["Durable Medical Equipment",{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"}]
["Orthotics/ Prosthetics","100% after office copay","100% after office copay",{"v":1,"d":"100%"}]
["Home Health Care",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Hospice Care",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Infertility","100% after copay(limited to 4 egg retrievals per lifetime)*","100% after copay(limited to 4 egg retrievals per lifetime)*","100% after copay(limited to 4 egg retrievals per lifetime)*"]
["Private Duty Nursing",{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":1,"d":"100%"}]
["Short Term Therapies","100% after office copay","100% after office copay","100% after office copay"]
["Skilled Nursing Facility","100% (120 day max)**","100% (120 day max)**","100% (120 day max)**"]
["Chiropractic Care","100% after office visit copay (30 visit max)*","100% after office visit copay (30 visit max)*","100% after office visit copay (30 visit max)*"]
["Vision Routine Eye Exam",{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"}]
["Vision Hardware","Not Covered","Not Covered","Not Covered"]
["Out of Network"]
["Deductible Individual",{"v":100,"d":"$100"},{"v":100,"d":"$100"},{"v":350,"d":"$350"}]
["Deductible Family",{"v":250,"d":"$250"},{"v":250,"d":"$250"},{"v":700,"d":"$700"}]
["Coinsurance",{"v":0.8,"d":"80%"},{"v":0.7,"d":"70%"},{"v":0.7,"d":"70%"}]
["Maximum Out of Pocket Individual*","$2,000*","$2,000*","$2,000*"]
["Maximum Out of Pocket Family*","$5,000*","$5,000*","$5,000*"]
["Benefit Maximum","Unlimited","Unlimited","Unlimited"]
["Lifetime Maximum","Unlimited","Unlimited","Unlimited"]
["Primary Care Office Visit","80% after deductible","70% after deductible","70% after deductible"]
["Specialist Office Visit","80% after deductible","70% after deductible","70% after deductible"]
["Maternity Visits","80% after deductible","70% after deductible","70% after deductible"]
["Allergy Testing and Treatment","80% after deductible","70% after deductible","70% after deductible"]
["Routine Physical","80% NO deductible","70% NO deductible","70% NO Deductible"]
["Routine GYN Exams","80% NO deductible","70% NO deductible","70% NO Deductible"]
["Routine PAP/Mammograms","80% NO deductible","70% NO deductible","70% NO Deductible"]
["Prostate/Colorectal Screening","80% NO deductible","70% NO deductible","70% NO Deductible"]
["Immunizations","80% NO deductible","70% NO deductible","70% NO Deductible"]
["Well Child Exams","80% NO deductible","70% NO deductible","70% NO Deductible"]
["Well Child Immunizations/Lead Screening","80% NO deductible","70% NO deductible","70% NO Deductible"]
["Laboratory office","80% after deductible","70% after deductible","70% after deductible"]
["Laboratory outpatient","80% after deductible","70% after deductible","70% after deductible"]
["X-Ray/Radiology Services Office","80% after deductible","70% after deductible","70% after deductible"]
["X-Ray/Radiology Services Outpatient","80% after deductible","70% after deductible","70% after deductible"]
["Inpatient Hospital- Facility Fees","80% after deductible","70% after deductible","70% after deductible"]
["Inpatient Hospital- Professional Fees","80% after deductible","70% after deductible","70% after deductible"]
["Emergency Room",{"v":25,"d":"$25"},{"v":50,"d":"$50"},{"v":125,"d":"$125"}]
["Ambulance","80% after deductible","70% after deductible","70% after deductible"]
["Outpatient Hospital- Facility Fees","80% after deductible","70% after deductible","70% after deductible"]
["Outpatient Hospital- Professional Fees","80% after deductible","70% after deductible","70% after deductible"]
["Ambulatory/Surgi-center","80% after deductible","70% after deductible","70% after deductible"]
["Mental Health/Hospital","80% after deductible","70% after deductible","70% after deductible"]
["Mental Health/Office","80% after deductible","70% after deductible","70% after deductible"]
["Substance/Alcohol Abuse/Hospital","80% after deductible","70% after deductible","70% after deductible"]
["Substance/Alcohol Abuse/Office","80% after deductible","70% after deductible","70% after deductible"]
["Acupuncture","Up to $60 Reimbursement\n*30 Visit MAX","Up to $60 Reimbursement\n*30 Visit MAX","Up to $60 Reimbursement\n*30 Visit MAX"]
["Bariatric Surgery","80% after deductible","70% after deductible","70% after deductible"]
["Diabetic Supplies","80% after deductible","70% after deductible","70% after deductible"]
["Durable Medical Equipment","80% after deductible","70% after deductible","70% after deductible"]
["Orthotics/ Prosthetics","80% after deductible","70% after deductible","70% after deductible"]
["Home Health Care","80% after deductible","70% after deductible","70% after deductible"]
["Hospice Care","80% after deductible","70% after deductible","70% after deductible"]
["Infertility","80% after deductible","70% after deductible","70% after deductible"]
["Private Duty Nursing","80% after deductible","70% after deductible","70% after deductible"]
["Short Term Therapies","Up to $52 Reimbursement\n*30 Visit MAX","Up to $52 Reimbursement\n*30 Visit MAX","Up to $52 Reimbursement\n*30 Visit MAX"]
["Skilled Nursing Facility","80% after deductible**(up to 120 days max combined)","70% after deductible**(up to 120 days max combined)","70% after deductible**(up to 120 days max combined)"]
["Chiropractic Care","Up to $35 Reimbursement\n*30 visit MAX","Up to $35 Reimbursement\n*30 visit MAX","Up to $35 Reimbursement\n*30 visit MAX"]
["Vision Routine Eye Exam","Not Covered","Not Covered","Not Covered"]
["Vision Hardware","Not Covered","Not Covered","Not Covered"]
["*Out of pocket maximum is In and Out of Network combined"]
["**The overall maximum per benefit period is 120 days combined in and out of network"]

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[]
[]
[]
["SHIF Aetna Plan Comparison for Ramapo Indian Hills Regional H.S. District"]
[]
["Carrier","Horizon BCBS of NJ","Aetna","Horizon BCBS of NJ","Aetna","Horizon BCBS of NJ","Aetna"]
["In-Network","Direct 10","Open Access 10","Direct 15","Open Access 15","NJ Educators Health Plan","NJ Educators Health Plan"]
["Deductible Individual","None","None","None","None","None","None"]
["Deductible Family","None","None","None","None","None","None"]
["Coinsurance",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Maximum Out of Pocket Individual*",{"v":400,"d":"$400"},{"v":400,"d":"$400"},{"v":400,"d":"$400"},{"v":400,"d":"$400"},{"v":500,"d":"$500"},{"v":500,"d":"$500"}]
["Maximum Out of Pocket Family*",{"v":1000,"d":"$1,000"},{"v":1000,"d":"$1,000"},{"v":1000,"d":"$1,000"},{"v":1000,"d":"$1,000"},{"v":1000,"d":"$1,000"},{"v":1000,"d":"$1,000"}]
["Benefit Maximum","Unlimited","Unlimited","Unlimited","Unlimited","Unlimited","Unlimited"]
["Lifetime Maximum","Unlimited","Unlimited","Unlimited","Unlimited","Unlimited","Unlimited"]
["Primary Care Office Visit",{"v":10,"d":"$10"},{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":10,"d":"$10"},{"v":10,"d":"$10"}]
["Specialist Office Visit",{"v":10,"d":"$10"},{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":15,"d":"$15"}]
["Maternity Visits","100% after copay(1st visit)","100% after copay(1st visit)","100% after copay(1st visit)","100% after copay(1st visit)","100% after copay(1st visit)","100% after copay(1st visit)"]
["Allergy Testing and Treatment",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Routine Physical",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Routine GYN Exams",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Routine PAP/Mammograms",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Prostate/Colorectal Screening",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Immunizations",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Well Child Exams",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Well Child Immunizations/Lead Screening",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Laboratory office",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Laboratory outpatient",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["X-Ray/Radiology Services Office",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["X-Ray/Radiology Services Outpatient",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Inpatient Hospital- Facility Fees",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Inpatient Hospital- Professional Fees",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Emergency Room",{"v":25,"d":"$25"},{"v":25,"d":"$25"},{"v":50,"d":"$50"},{"v":50,"d":"$50"},{"v":125,"d":"$125"},{"v":125,"d":"$125"}]
["Ambulance",{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"}]
["Outpatient Hospital- Facility Fees",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Outpatient Hospital- Professional Fees",{"v":100,"d":"$100"},{"v":100,"d":"$100"},{"v":100,"d":"$100"},{"v":100,"d":"$100"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Ambulatory/Surgi-center",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Mental Health/Hospital",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Mental Health/Office",{"v":10,"d":"$10"},{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":15,"d":"$15"}]
["Substance/Alcohol Abuse/Hospital",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Substance/Alcohol Abuse/Office",{"v":10,"d":"$10"},{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":15,"d":"$15"}]
["Acupuncture",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Bariatric Surgery",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Diabetic Supplies",{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Durable Medical Equipment",{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"}]
["Orthotics/ Prosthetics","100% after office copay","100% after office copay","100% after office copay","100% after office copay",{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Home Health Care",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Hospice Care",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Infertility","100% after copay(limited to 4 egg retrievals per lifetime)*","100% after copay(limited to 4 egg retrievals per lifetime)*","100% after copay(limited to 4 egg retrievals per lifetime)*","100% after copay(limited to 4 egg retrievals per lifetime)*","100% after copay(limited to 4 egg retrievals per lifetime)*","100% after copay(limited to 4 egg retrievals per lifetime)*"]
["Private Duty Nursing",{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":0.9,"d":"90%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
["Short Term Therapies","100% after office copay","100% after office copay","100% after office copay","100% after office copay","100% after office copay","100% after office copay"]
["Skilled Nursing Facility","100% (120 day max)**","100% (120 day max)**","100% (120 day max)**","100% (120 day max)**","100% (120 day max)**","100% (120 day max)**"]
["Chiropractic Care","100% after office visit copay (30 visit max)*","100% after office visit copay (30 visit max)*","100% after office visit copay (30 visit max)*","100% after office visit copay (30 visit max)*","100% after office visit copay (30 visit max)*","100% after office visit copay (30 visit max)*"]
["Vision Routine Eye Exam",{"v":10,"d":"$10"},{"v":10,"d":"$10"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":15,"d":"$15"},{"v":15,"d":"$15"}]
["Vision Hardware","Not Covered","Not Covered","Not Covered","Not Covered","Not Covered","Not Covered"]
["Out of Network"]
["Deductible Individual",{"v":100,"d":"$100"},{"v":100,"d":"$100"},{"v":100,"d":"$100"},{"v":100,"d":"$100"},{"v":350,"d":"$350"},{"v":350,"d":"$350"}]
["Deductible Family",{"v":250,"d":"$250"},{"v":250,"d":"$250"},{"v":250,"d":"$250"},{"v":250,"d":"$250"},{"v":700,"d":"$700"},{"v":700,"d":"$700"}]
["Coinsurance",{"v":0.8,"d":"80%"},{"v":0.8,"d":"80%"},{"v":0.7,"d":"70%"},{"v":0.7,"d":"70%"},{"v":0.7,"d":"70%"},{"v":0.7,"d":"70%"}]
["Maximum Out of Pocket Individual*","$2,000*","$2,000*","$2,000*","$2,000*","$2,000*","$2,000*"]
["Maximum Out of Pocket Family*","$5,000*","$5,000*","$5,000*","$5,000*","$5,000*","$5,000*"]
["Benefit Maximum","Unlimited","Unlimited","Unlimited","Unlimited","Unlimited","Unlimited"]
["Lifetime Maximum","Unlimited","Unlimited","Unlimited","Unlimited","Unlimited","Unlimited"]
["Primary Care Office Visit","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Specialist Office Visit","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Maternity Visits","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Allergy Testing and Treatment","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Routine Physical","80% NO deductible","80% NO deductible","70% NO deductible","70% NO deductible","70% NO Deductible","70% NO Deductible"]
["Routine GYN Exams","80% NO deductible","80% NO deductible","70% NO deductible","70% NO deductible","70% NO Deductible","70% NO Deductible"]
["Routine PAP/Mammograms","80% NO deductible","80% NO deductible","70% NO deductible","70% NO deductible","70% NO Deductible","70% NO Deductible"]
["Prostate/Colorectal Screening","80% NO deductible","80% NO deductible","70% NO deductible","70% NO deductible","70% NO Deductible","70% NO Deductible"]
["Immunizations","80% NO deductible","80% NO deductible","70% NO deductible","70% NO deductible","70% NO Deductible","70% NO Deductible"]
["Well Child Exams","80% NO deductible","80% NO deductible","70% NO deductible","70% NO deductible","70% NO Deductible","70% NO Deductible"]
["Well Child Immunizations/Lead Screening","80% NO deductible","80% NO deductible","70% NO deductible","70% NO deductible","70% NO Deductible","70% NO Deductible"]
["Laboratory office","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Laboratory outpatient","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["X-Ray/Radiology Services Office","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["X-Ray/Radiology Services Outpatient","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Inpatient Hospital- Facility Fees","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Inpatient Hospital- Professional Fees","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Emergency Room",{"v":25,"d":"$25"},{"v":25,"d":"$25"},{"v":50,"d":"$50"},{"v":50,"d":"$50"},{"v":125,"d":"$125"},{"v":125,"d":"$125"}]
["Ambulance","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Outpatient Hospital- Facility Fees","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Outpatient Hospital- Professional Fees","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Ambulatory/Surgi-center","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Mental Health/Hospital","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Mental Health/Office","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Substance/Alcohol Abuse/Hospital","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Substance/Alcohol Abuse/Office","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Acupuncture","Up to $60 Reimbursement\n*30 Visit MAX","Up to $60 Reimbursement\n*30 Visit MAX","Up to $60 Reimbursement\n*30 Visit MAX","Up to $60 Reimbursement\n*30 Visit MAX","Up to $60 Reimbursement\n*30 Visit MAX","Up to $60 Reimbursement\n*30 Visit MAX"]
["Bariatric Surgery","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Diabetic Supplies","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Durable Medical Equipment","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Orthotics/ Prosthetics","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Home Health Care","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Hospice Care","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Infertility","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Private Duty Nursing","80% after deductible","80% after deductible","70% after deductible","70% after deductible","70% after deductible","70% after deductible"]
["Short Term Therapies","Up to $52 Reimbursement\n*30 Visit MAX","Up to $52 Reimbursement\n*30 Visit MAX","Up to $52 Reimbursement\n*30 Visit MAX","Up to $52 Reimbursement\n*30 Visit MAX","Up to $52 Reimbursement\n*30 Visit MAX","Up to $52 Reimbursement\n*30 Visit MAX"]
["Skilled Nursing Facility","80% after deductible**(up to 120 days max combined)","80% after deductible**(up to 120 days max combined)","70% after deductible**(up to 120 days max combined)","70% after deductible**(up to 120 days max combined)","70% after deductible**(up to 120 days max combined)","70% after deductible**(up to 120 days max combined)"]
["Chiropractic Care","Up to $35 Reimbursement\n*30 visit MAX","Up to $35 Reimbursement\n*30 visit MAX","Up to $35 Reimbursement\n*30 visit MAX","Up to $35 Reimbursement\n*30 visit MAX","Up to $35 Reimbursement\n*30 visit MAX","Up to $35 Reimbursement\n*30 visit MAX"]
["Vision Routine Eye Exam","Not Covered","Not Covered","Not Covered","Not Covered","Not Covered","Not Covered"]
["Vision Hardware","Not Covered","Not Covered","Not Covered","Not Covered","Not Covered","Not Covered"]
["*Out of pocket maximum is In and Out of Network combined"]
["**The overall maximum per benefit period is 120 days combined in and out of network"]