{"text_format":"1","workbook":"xlsx","n_sheets":2,"sheets":["WAIVER CENSUS","Contract Codes"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":0,"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":"WAIVER CENSUS","index":0,"n_rows":10,"n_cols":8,"rows_kept":10,"cut":false,"hidden":false,"merged":[[1,1,1,7],[2,1,2,7],[3,1,3,2],[3,3,3,7],[4,1,4,7]]}
[]
[null,"2019 - Anthem Blue Cross/Blue Shield -  Nevada Small Group Waiver Census"]
[]
[null,"Name of Employer"]
[null,"* = Required Fields"]
[null,"MEMBER SSN *","LAST NAME *","FIRST NAME *","COVERAGE WAIVERED *","RELATIONSHIP CODE *","REASON *","EXPLANATION (If Required) *"]
[null,123456789,"Smith","John","Medical","Subscriber","Covered by spouse's/domestic partner's group coverage"]
[null,null,null,null,"Dental",null,"No coverage"]
[null,null,null,null,"Vision",null,"No coverage"]
[null,456789123,"Jones","Amy","Medical","Subscriber","Medicare/Medicaid/VA"]

{"sheet":"Contract Codes","index":1,"n_rows":109,"n_cols":7,"rows_kept":109,"cut":false,"hidden":true,"merged":[]}
["Medical Plans",null,"Dental Plans",null,"Life Plans",null,"Gender"]
[]
["20XJ - Pathway Tiered Network - Choice Gold PPO 250/20%/4500",null,"1FUA - Dental Pediatric",null,"13WM - Age 2 - 9 Group Term Life /  AD&D  (Flat)",null,"M"]
["1Z26 - Pathway Tiered Network - Choice Gold PPO 500/10%/6850 ",null,"1FUB - Dental Family",null,"13WN - Age 2 - 9 Group Term Life / AD&D  (Salary)",null,"F"]
["20XN - Pathway Tiered Network - Choice Gold PPO 750/20%/4500",null,"1FUC - Dental Family Enhanced",null,"0T4P - Age 2 - 9 Dependent Life / AD&D $10,000  (Flat)"]
["1YFP - Pathway Tiered Network - Choice Gold PPO 1000/10%/6000 ",null,"1R6U - Value Prime NV-1A",null,"0T4Q - Age 2 - 9 Dependent Life / AD&D $5,000  (Flat)"]
["20XP - Pathway Tiered Network - Choice Gold PPO 1500/20%/4000",null,"1R6T - Value Complete NV-1B",null,"0T4R - Age 2 - 9 Dependent Life / AD&D $10,000  (Salary)",null,"Relationship Code"]
["1YFQ - Pathway Tiered Network - Choice Gold PPO 1500/10%/6000 ",null,"1RBB - Classic Prime NV-2A",null,"0T4S - Age 2 - 9 Dependent Life / AD&D $5,000  (Salary)"]
["20XK - Pathway Tiered Network - Choice Silver PPO 1000/30%/6850",null,"1R67 - Classic Prime NV-2B",null,"2AKN - Composite 10 - 50 Term Life w/wo AD&D/Dep  (Flat/Salary)",null,"Subscriber"]
["20XL - Pathway Tiered Network - Choice Silver PPO 1750/40%/6000 Plus",null,"1R68 - Classic Prime NV-2C",null,"2AKP - Composite 10 - 50 Term Life w/wo AD&D/Dep  (Flat/Salary)",null,"Spouse"]
["20XM - Pathway Tiered Network - Choice Silver PPO 2500/40%/6000",null,"1R69 - Classic Prime NV-2D",null,"2AKQ - Composite 10 - 50 Term Life w/wo AD&D/Dep  (Flat/Salary)",null,"Child"]
["1Z27 - Pathway Tiered Network - Choice Silver PPO 3500/20%/6850 ",null,"1R6A - Classic Prime NV-2E",null,"2AKR - Composite 10 - 50 Term Life w/wo AD&D/Dep  (Flat/Salary)",null,"Handicapped"]
["1Z2B - Pathway Tiered Network - Choice Silver PPO 2500/25%/6850 ",null,"1R6B - Classic Prime NV-2F",null,"2AKS - Composite 10 - 50 Term Life w/wo AD&D/Dep  (Flat/Salary)",null,"Student"]
["1Z2A - PPO - Gold PPO 250/20%/5500 ",null,"1R6C - Classic Prime NV-2G",null,"2AKT - Composite 10 - 50 Term Life w/wo AD&D/Dep  (Flat/Salary)",null,"Domestic Partner"]
["1Z23 - PPO - Gold PPO 500/20%/4500 ",null,"1R6D - Classic Prime NV-2H",null,"2AL0 - Age 10 - 50 Voluntary Term Life w/wo AD&D/Dep   (Flat/Salary)"]
["1Z29 - PPO - Gold PPO 500/30%/5000 ",null,"1R6E - Classic Prime NV-2J",null,"2AL1 - Age 10 - 50 Voluntary Term Life w/wo AD&D/Dep   (Flat/Salary)"]
["1Z22 - PPO - Gold PPO 1000/20%/5000 ",null,"1R6F - Classic Prime NV-2K",null,"2AL2 - Age 10 - 50 Voluntary Term Life w/wo AD&D/Dep   (Flat/Salary)",null,"Group Type"]
["1Z21 - PPO - Gold PPO 1500/30%/4500 ",null,"1R6G - Classic Prime NV-2L",null,"2AL3 - Age 10 - 50 Voluntary Term Life w/wo AD&D/Dep   (Flat/Salary)"]
["1Z1X - PPO - Gold PPO 2000/20%/4000 ",null,"1R6H - Classic Prime NV-2M",null,"2AL4 - Age 10 - 50 Voluntary Term Life w/wo AD&D/Dep   (Flat/Salary)",null,"Active"]
["1Z1B - PPO - Gold PPO 2000/40%/3500 ",null,"1R6J - Classic Prime NV-2N",null,"2AL5 - Age 10 - 50 Voluntary Term Life w/wo AD&D/Dep   (Flat/Salary)",null,"Cobra"]
["1Z15 - PPO - Silver PPO 1500/30%/6850 Plus",null,"1R6K - Classic Prime NV-2P",null,"2AKU - Age 10 - 50 Opt Life w/wo AD&D/Dep (Flat/Salary)",null,"Retiree"]
["1Z24 - PPO - Silver PPO 1750/40%/6850",null,"1R6L - Classic Prime NV-2Q",null,"2AKV - Age 10 - 50 Opt Life w/wo AD&D/Dep (Flat/Salary)"]
["1Z16 - PPO - Silver PPO 2000/50%/6850",null,"250H - Classic Prime NV-2R",null,"2AKW - Age 10 - 50 Opt Life w/wo AD&D/Dep (Flat/Salary)"]
["1Z1N - PPO - Silver PPO 2600/20%/4500 w/ H.S.A.",null,"250J - Classic Prime NV-2S",null,"2AKX - Age 10 - 50 Opt Life w/wo AD&D/Dep (Flat/Salary)",null,"COB"]
["1Z1T - PPO - Silver PPO 3500/0%/3500 w/ H.S.A.",null,"250L - Classic Prime NV-2U",null,"2AKY - Age 10 - 50 Opt Life w/wo AD&D/Dep (Flat/Salary)"]
["1Z14 - PPO - Bronze PPO 5000/20%/6500 w/ H.S.A.",null,"250M - Classic Prime NV-2V",null,"2AKZ - Age 10 - 50 Opt Life w/wo AD&D/Dep (Flat/Salary)",null,"Y"]
["1Z1M - PPO - Bronze PPO 5900/0%/6850 Plus",null,"250N - Classic Prime NV-2W",null,"0TE7 - Age 2 - 9 LTD GOLD:  60% benefit / Max amt $3,000",null,"N"]
["1Z1A - PPO - Bronze PPO 6000/0%/6000 w/ H.S.A.",null,"250P - Classic Prime NV-2X",null,"0TEK - Age 2 - 9 LTD GOLD:  60% benefit / Max amt $6,000"]
["1Z17 - PPO - Bronze PPO 6550/0%/6550 w/ H.S.A.",null,"250Q - Classic Prime NV-2Y",null,"0TEX - Age 2 - 9 LTD GOLD:  60% benefit / Max amt $3,000"]
["1Z28 - Pathway PPO - Gold Pathway PPO 500/20%/3500 ",null,"250R - Classic Prime NV-2Z",null,"0TF9 - Age 2 - 9 LTD GOLD:  60% benefit / Max amt $6,000",null,"Current PCP"]
["1Z19 - Pathway PPO - Gold Pathway PPO 500/20%/4500 ",null,"1R6M - Enhanced Prime NV-3A",null,"0TFM - Age 2 - 9 LTD SILVER:  60% benefit / Max amt $3,000"]
["1Z1C - Pathway PPO - Gold Pathway PPO 750/20%/4500 ",null,"1R6N - Enhanced Prime NV-3B",null,"0TFZ - Age 2 - 9 LTD SILVER:  60% benefit / Max amt $6,000",null,"Y"]
["1Z1P - Pathway PPO - Gold Pathway PPO 1000/20%/4000/15 ",null,"1R6P - Enhanced Prime NV-3C",null,"0TGB - Age 2 - 9 LTD SILVER:  60% benefit / Max amt $3,000",null,"N"]
["1Z1V - Pathway PPO - Gold Pathway PPO 1000/20%/4000/20 ",null,"1R6Q - Enhanced Prime NV-3D",null,"0TGP - Age 2 - 9 LTD SILVER:  60% benefit / Max amt $6,000"]
["1Z1G - Pathway PPO - Gold Pathway PPO 1000/20%/4500 Plus ",null,"1R6R - Enhanced Prime NV-3E",null,"0TH1 - Age 2 - 9 LTD BRONZE: 60% benefit / Max amt $3,000"]
["1Z1Y - Pathway PPO - Silver Pathway PPO 2000/30%/5500 Plus",null,"1R6S - Enhanced Prime NV-3F",null,"0THD - Age 2 - 9 LTD BRONZE: 60% benefit / Max amt $6,000",null,"Cobra Qualifying Event"]
["1Z1F - Pathway PPO - Silver Pathway PPO 3000/30%/4000 Plus",null,"24Z8 - Enhanced Prime NV-3H",null,"2AHW - Composite 10 - 50 NV LTD: 40% benefit/ Max amt $15,000"]
["1Z1W - Pathway PPO - Bronze Pathway PPO 3250/50%/6550 Plus w/ H.S.A.",null,"1RAD - (Voluntary) Prime NV-4A",null,"2AHX - Composite 10 - 50 NV LTD: 50% benefit/ Max amt $15,000",null,"Termination"]
["1Z1E - Pathway PPO - Bronze Pathway PPO 5000/30%/6850 Plus ",null,"2545 - (Voluntary) Prime NV-4B",null,"2AHY - Composite 10 - 50 NV LTD: 60% benefit/ Max amt $15,000",null,"Voluntary Termination"]
["1Z1K - Pathway PPO - Bronze Pathway PPO 5250/0%/6550 Plus w/ H.S.A. ",null,"2546 - (Voluntary) Prime NV-4C",null,"2AHZ - Composite 10 - 50 NV LTD: 67% benefit/ Max amt $15,000",null,"Part Time Termination"]
["1Z1U - Pathway PPO - Bronze Pathway PPO 5850/30%/6850 Plus ",null,"2547 - (Voluntary) Prime NV-4D",null,"2AJ0 - Age 10 - 50 NV Voluntary LTD: 50% benefit (Salary)",null,"Retirement"]
["1Z1R - Pathway HMO - Gold Pathway HMO 30/20%/6000 ",null,null,null,"2AJ1 - Age 10 - 50 NV Voluntary LTD: 60% benefit (Salary)",null,"Hours Reduction"]
["1Z1Z - Pathway HMO - Gold Pathway HMO 35/30%/6350 ",null,null,null,"0T5Q - Age 2 - 9 NV STD - Flat Amount $250/week",null,"Layoff"]
["1Z1L - Pathway HMO - Gold Pathway HMO 1000/10%/5500 Plus ",null,"Vision Plans",null,"0T6C - Age 2 - 9 NV STD - Flat Amount $250/week",null,"SS Disability"]
["1Z1J - Pathway HMO - Silver Pathway HMO 1500/30%/5500 Plus",null,null,null,"0T61 - Age 2 - 9 NV STD - Flat Amount $250/week",null,"Death of Employee"]
["1Z1H - Pathway HMO - Silver Pathway HMO 3000/20%/6000 Plus",null,"0RLR - Anthem Blue View Vision Plan A1",null,"0T6P - Age 2 - 9 NV STD - Flat Amount $250/week"]
["1Z1S - Pathway HMO - Bronze Pathway HMO 5000/30%/6850 Plus",null,"0U07 - Anthem Blue View Vision Plan A2",null,"0T70 - Age 2 - 9 NV STD - Flat Amount $250/week"]
[null,null,"0UHR - Anthem Blue View Vision Plan A3",null,"0T7B - Age 2 - 9 NV STD - Flat Amount $250/week",null,"Waiver/Declining Coverage"]
[null,null,"0RLS - Anthem Blue View Vision Plan A4",null,"0T9L - Age 2 - 9 NV STD - 60% benefit payment of salary"]
[null,null,"0RLT - Anthem Blue View Vision Plan A5",null,"0TA8 - Age 2 - 9 NV STD - 60% benefit payment of salary",null,"Covered by spouse's/domestic partner's group coverage"]
[null,null,"24P0 - Anthem Blue View Vision Plan A6",null,"0T9X - Age 2 - 9 NV STD - 60% benefit payment of salary",null,"Enrolled in other insurance - provide company name and plan"]
[null,null,"0RLU - Anthem Blue View Vision Plan B1",null,"0TAK - Age 2 - 9 NV STD - 60% benefit payment of salary",null,"Enrolled in individual coverage"]
[null,null,"0RLX - Anthem Blue View Vision Plan B2",null,"0TAW - Age 2 - 9 NV STD - 60% benefit payment of salary",null,"Medicare/Medicaid/VA"]
[null,null,"0RLV - Anthem Blue View Vision Plan B3",null,"0TB7 - Age 2 - 9 NV STD - 60% benefit payment of salary",null,"Other - please explain"]
[null,null,"0RLW - Anthem Blue View Vision Plan B4",null,"0TBJ - Age 2 - 9 NV STD - 67% benefit payment of salary",null,"No coverage"]
[null,null,"24P1 - Anthem Blue View Vision Plan B5",null,"0TC5 - Age 2 - 9 NV STD - 67% benefit payment of salary"]
[null,null,"24P2 - Anthem Blue View Vision Plan B6",null,"0TBU - Age 2 - 9 NV STD - 67% benefit payment of salary"]
[null,null,"0RLY - Anthem Blue View Vision Plan C1",null,"0TCG - Age 2 - 9 NV STD - 67% benefit payment of salary",null,"Medicare Qualifying Event"]
[null,null,"0RLZ - Anthem Blue View Vision Plan C2",null,"0TCT - Age 2 - 9 NV STD - 67% benefit payment of salary"]
[null,null,"0RM0 - Anthem Blue View Vision Plan C3",null,"0TD4 - Age 2 - 9 NV STD - 67% benefit payment of salary",null,"Age"]
[null,null,"0U08 - Anthem Blue View Vision Plan C4",null,"2AHG - Composite 10 - 50 NV STD - Flat Amount $100/week",null,"Disability"]
[null,null,"0RM1 - Anthem Blue View Vision Plan C5",null,"2AHH - Composite 10 - 50 NV STD - Flat Amount $150/week",null,"ESRD:  Onset Date_________"]
[null,null,"0RM2 - Anthem Blue View Vision Plan C6",null,"2AHJ - Composite 10 - 50 NV STD - Flat Amount $200/week"]
[null,null,"0WAL - Anthem Blue View Vision Plan C7",null,"2AHK - Composite 10 - 50 NV STD - Flat Amount $250/week"]
[null,null,"24P3 - Anthem Blue View Vision Plan C8",null,"2AHL - Composite 10 - 50 NV STD - 40% benefit  payment of salary ",null,"Hours Worked"]
[null,null,"24P4 - Anthem Blue View Vision Plan C9",null,"2AHM - Composite 10 - 50 NV STD - 50% benefit  payment of salary "]
[null,null,"0U0A - Anthem Blue View Vision Plan MO1",null,"2AHN - Composite 10 - 50 NV STD - 60% benefit  payment of salary ",null,"30+"]
[null,null,"0U0B - Anthem Blue View Vision Plan MO2",null,"2AHP - Composite 10 - 50 NV STD - 67% benefit  payment of salary "]
[null,null,"0U09 - Anthem Blue View Vision Plan MO3",null,"2AHQ - Composite 10 - 50 NV STD - 70% benefit  payment of salary "]
[null,null,"0U0C - Anthem Blue View Vision Plan MO4",null,"2AHR - Age 10 - 50 Voluntary STD - Flat Amount $200 ",null,"Coverage Waivered"]
[null,null,"24NW - Anthem Blue View Vision Plan MO5",null,"2AHS - Age 10 - 50 Voluntary STD - Flat Amount $250 "]
[null,null,"24NX - Anthem Blue View Vision Plan MO6",null,"2AHT - Age 10 - 50 Voluntary STD - Flat Amount $500",null,"Medical"]
[null,null,"0U0D - Anthem Blue View Vision Plan EX01",null,"2AHU - Age 10 - 50 Voluntary STD - 50% benefit of salary",null,"Dental"]
[null,null,"0U0E - Anthem Blue View Vision Plan EX02",null,"2AHV - Age 10 - 50 Voluntary STD - 60% benefit of salary",null,"Vision"]
[null,null,"0U0F - Anthem Blue View Vision Plan EX03",null,null,null,"Life/AD&D"]
[null,null,"0U0G - Anthem Blue View Vision Plan EX04",null,null,null,"STD"]
[null,null,"0U0H - Anthem Blue View Vision Plan EX05",null,null,null,"LTD"]
[null,null,"0RQN - Voluntary Anthem Blue View Vision Plan A1"]
[null,null,"0U0J - Voluntary Anthem Blue View Vision Plan A2"]
[null,null,"0UHQ - Voluntary Anthem Blue View Vision Plan A3"]
[null,null,"0RQP - Voluntary Anthem Blue View Vision Plan A4"]
[null,null,"0RQQ - Voluntary Anthem Blue View Vision Plan A5"]
[null,null,"24P5 - Voluntary Anthem Blue View Vision Plan A6"]
[null,null,"0RQR - Voluntary Anthem Blue View Vision Plan B1"]
[null,null,"0RQU - Voluntary Anthem Blue View Vision Plan B2"]
[null,null,"0RQS - Voluntary Anthem Blue View Vision Plan B3"]
[null,null,"0RQT - Voluntary Anthem Blue View Vision Plan B4"]
[null,null,"24P6 - Voluntary Anthem Blue View Vision Plan B5"]
[null,null,"24P7 - Voluntary Anthem Blue View Vision Plan B6"]
[null,null,"0RQV - Voluntary Anthem Blue View Vision Plan C1"]
[null,null,"0RQW - Voluntary Anthem Blue View Vision Plan C2"]
[null,null,"0RQX - Voluntary Anthem Blue View Vision Plan C3"]
[null,null,"0U0K - Voluntary Anthem Blue View Vision Plan C4"]
[null,null,"0RQY - Voluntary Anthem Blue View Vision Plan C5"]
[null,null,"0RQZ - Voluntary Anthem Blue View Vision Plan C6"]
[null,null,"0WAM - Voluntary Anthem Blue View Vision Plan C7"]
[null,null,"24P8 - Voluntary Anthem Blue View Vision Plan C8"]
[null,null,"24P9 - Voluntary Anthem Blue View Vision Plan C9"]
[null,null,"0U0M - Voluntary Anthem Blue View Vision Plan MO1"]
[null,null,"0U0N - Voluntary Anthem Blue View Vision Plan MO2"]
[null,null,"0U0L - Voluntary Anthem Blue View Vision Plan MO3"]
[null,null,"0U0P - Voluntary Anthem Blue View Vision Plan MO4"]
[null,null,"24NY - Voluntary Anthem Blue View Vision Plan MO5"]
[null,null,"24NZ - Voluntary Anthem Blue View Vision Plan MO6"]
[null,null,"0U0Q - Voluntary Anthem Blue View Vision Plan EX01"]
[null,null,"0U0R - Voluntary Anthem Blue View Vision Plan EX02"]
[null,null,"0U0S - Voluntary Anthem Blue View Vision Plan EX03"]
[null,null,"0U0T - Voluntary Anthem Blue View Vision Plan EX04"]
[null,null,"0U0U - Voluntary Anthem Blue View Vision Plan EX05"]