{"text_format":"1","workbook":"xlsx","n_sheets":13,"sheets":["NEW Enrollment Form","refs and calcs","MUGS template","CAT template","eServices Template template old","eServices Template template new","Medical Waivers","Tools","Supp_Life_STD_LTD_Info","Enrollment Form Explanations","PlanSource MUW Export","Counts_Relation_Tier_Ancillary","Utilization"],"not_rendered":{"charts":0,"images":22,"macros":1,"external_links":2,"defined_names":168,"comments":4,"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":"NEW Enrollment Form","index":0,"n_rows":6,"n_cols":76,"rows_kept":6,"cut":false,"hidden":false,"merged":[[1,1,1,74],[4,8,4,9],[3,8,3,11]]}
[]
["NEW BUSINESS ENROLLMENT SPREADSHEET                                       NEW BUSINESS ENROLLMENT SPREADSHEET                                        NEW BUSINESS ENROLLMENT SPREADSHEET                                        NEW BUSINESS ENROLLMENT SPREADSHEET                                         NEW BUSINESS ENROLLMENT SPREADSHEET                                        NEW BUSINESS ENROLLMENT SPREADSHEET                                        NEW BUSINESS ENROLLMENT SPREADSHEET                                        NEW BUSINESS ENROLLMENT SPREADSHEET                                        NEW BUSINESS ENROLLMENT SPREADSHEET                                        NEW BUSINESS ENROLLMENT SPREADSHEET                                        NEW BUSINESS ENROLLMENT SPREADSHEET                                       NEW BUSINESS ENROLLMENT SPREADSHEET","NEW BUSINESS ENROLLMENT SPREADSHEET                                           NEW BUSINESS ENROLLMENT SPREADSHEET                                                              NEW BUSINESS ENROLLMENT SPREADSHEET                                                              NEW BUSINESS ENROLLMENT SPREADSHEET                                                                          NEW BUSINESS ENROLLMENT SPREADSHEET                                                     NEW BUSINESS ENROLLMENT SPREADSHEET                                                    NEW BUSINESS ENROLLMENT SPREADSHEET                                                  NEW BUSINESS ENROLLMENT SPREADSHEET                                                 NEW BUSINESS ENROLLMENT SPREADSHEET                                                 NEW BUSINESS ENROLLMENT SPREADSHEET"]
["* Required Fields for all Subscribers & Dependents ",null,null,null,null,null,null,null,null,null,null,null,null,"A. Employee (Subscriber) Information",null,null,null,null,null,null,null,"B. Employer Section",null,null,null,null,"C. Product Selection",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"D. Other Medical Info",null,null,null,null,null,null,null,"E. Medicare Information",null,null,null,null,"       F. UHC Internal Only - FACETS INFO - Heritage/RV/NHP",null,null,null,null,null,null,null,"G. UHC - Internal Use Only."]
[null,null,null,null,null,null,null,null,"Underwriting ONLY (2-50 Grandfathered or 51+)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Life coverage amounts exceeding the guarantee issue will not be installed until proof of good health is provided and approved.   Completion of a Group Life and Disability Employee Enrollment form is required if Life exceeds guarantee issue amount."]
[null,null,null,null,null,null,null,null,"Height"]
["* Employee ID/SSN","* Dependent ID/SSN","* Relationship","* Last Name","* First Name","Middle Initial","* Sex","* Date of Birth\n(MM/DD/YYYY)","Feet","Inches","Weight","Tobacco","Twin?","Street Address","City","State","ZIP","Home Phone","Work Phone (Optional)","Employee Email Address","Tier\n(Optional)\nTotals in Next Tab","Hire Date\n(MM/DD/YY)","Coverage Effective Date\n(MM/DD/YY)","COBRA Begin Date\n(MM/DD/YY)","COBRA End Date\n(MM/DD/YY)","Retire Date (51+ only)\n(MM/DD/YY)","Medical Coverage","Medical Plan\n(Multi-Choice Only)","PCP\n(HMO Only)","Dental Coverage","Dental Plan\n(Dual Option Only)","PCD\n(DHMO Only)","Vision Coverage","PRIME Life Coverage","PRIME Life Coverage Amount","Employee Annual Salary","PRIME Life Occupational Class","AD&D Amount","Dependent Life","Hours Worked","Supplemental Life / STD / LTD OC Class","EE Supplemental Life Plan","EE Supplemental Life Amount","Grandfathered EE Supp. Life Amount","SP Supplemental Life Amount","CH Supplemental Life Amount","STD (Salary) Coverage","STD\nBuyup?","LTD (Salary) Coverage","LTD\nBuyup?","* COB - Other Medical ","COB (begin date)\n(MM/DD/YY)","COB (end date)\n(MM/DD/YY)","AO Coverage?","Eligibility Reason","Ineligibility Reason","Primary coverage Code","Part A Start Date","Part A End Date","Part B Start Date","Part B End Date","Part D Start Date","Part D End Date","RV Super Group","RV Class ID","RV Sub Group (Billing)","RV Med Network Code","RV Med Product","NHP Group Number","On Prior Carrier? ","Optum Bank HSA Application","Medical Waiver Reason","Health Transfer\n(Completed by C.I.)","Covered","Policy Number","Member HBX ID"]

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["$10k","$5k",null,{"$f":"Supp_Life_STD_LTD_Info!B6","v":2},{"$f":"Supp_Life_STD_LTD_Info!C6","v":0},{"$f":"Supp_Life_STD_LTD_Info!D6","v":0},{"$f":"Supp_Life_STD_LTD_Info!E6","v":0},{"$f":"Supp_Life_STD_LTD_Info!F6","v":0},{"$f":"Supp_Life_STD_LTD_Info!G6","v":0},{"$f":"Supp_Life_STD_LTD_Info!H6","v":0},{"$f":"Supp_Life_STD_LTD_Info!I6","v":0},"$20k",null,"Check_Plan_Medical"]
["$20k","$10k",null,{"$f":"Supp_Life_STD_LTD_Info!B7","v":3},{"$f":"Supp_Life_STD_LTD_Info!C7","v":0},{"$f":"Supp_Life_STD_LTD_Info!D7","v":0},{"$f":"Supp_Life_STD_LTD_Info!E7","v":0},{"$f":"Supp_Life_STD_LTD_Info!F7","v":0},{"$f":"Supp_Life_STD_LTD_Info!G7","v":0},{"$f":"Supp_Life_STD_LTD_Info!H7","v":0},{"$f":"Supp_Life_STD_LTD_Info!I7","v":0},"$30k",null,"Check_Coverage_Medical"]
["$30k","$15k",null,{"$f":"Supp_Life_STD_LTD_Info!B8","v":4},{"$f":"Supp_Life_STD_LTD_Info!C8","v":0},{"$f":"Supp_Life_STD_LTD_Info!D8","v":0},{"$f":"Supp_Life_STD_LTD_Info!E8","v":0},{"$f":"Supp_Life_STD_LTD_Info!F8","v":0},{"$f":"Supp_Life_STD_LTD_Info!G8","v":0},{"$f":"Supp_Life_STD_LTD_Info!H8","v":0},{"$f":"Supp_Life_STD_LTD_Info!I8","v":0},"$40k",null,"Check_Coverage_Dental"]
[null,null,null,{"$f":"Supp_Life_STD_LTD_Info!B9","v":5},{"$f":"Supp_Life_STD_LTD_Info!C9","v":0},{"$f":"Supp_Life_STD_LTD_Info!D9","v":0},{"$f":"Supp_Life_STD_LTD_Info!E9","v":0},{"$f":"Supp_Life_STD_LTD_Info!F9","v":0},{"$f":"Supp_Life_STD_LTD_Info!G9","v":0},{"$f":"Supp_Life_STD_LTD_Info!H9","v":0},{"$f":"Supp_Life_STD_LTD_Info!I9","v":0},"$50k",null,"Check_Plan_Dental"]
["Y",null,null,{"$f":"Supp_Life_STD_LTD_Info!B10","v":6},{"$f":"Supp_Life_STD_LTD_Info!C10","v":0},{"$f":"Supp_Life_STD_LTD_Info!D10","v":0},{"$f":"Supp_Life_STD_LTD_Info!E10","v":0},{"$f":"Supp_Life_STD_LTD_Info!F10","v":0},{"$f":"Supp_Life_STD_LTD_Info!G10","v":0},{"$f":"Supp_Life_STD_LTD_Info!H10","v":0},{"$f":"Supp_Life_STD_LTD_Info!I10","v":0},"$60k",null,"Check_Coverage_Vision"]
["N",null,null,{"$f":"Supp_Life_STD_LTD_Info!B11","v":7},{"$f":"Supp_Life_STD_LTD_Info!C11","v":0},{"$f":"Supp_Life_STD_LTD_Info!D11","v":0},{"$f":"Supp_Life_STD_LTD_Info!E11","v":0},{"$f":"Supp_Life_STD_LTD_Info!F11","v":0},{"$f":"Supp_Life_STD_LTD_Info!G11","v":0},{"$f":"Supp_Life_STD_LTD_Info!H11","v":0},{"$f":"Supp_Life_STD_LTD_Info!I11","v":0},"$70k","AA","Check_Coverage_DepLife"]
[null,null,null,null,null,null,null,null,null,null,null,"$80k","AE","Check_Coverage_PrimeLife"]
[{"$f":"IF(A10=\"\",\"\",\"none\")","v":""},null,null,0,null,"N",null,null,null,null,null,"$90k","AK","Check_Salary"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!C5=\"\",\"\",Supp_Life_STD_LTD_Info!C5)","v":""},null,null,1,null,"Y",null,null,null,null,null,"$100k","AL","Check_PrimeOccClass"]
[{"$f":"IF(A12=\"\",\"\",\"none\")","v":""},null,null,2,null,"U",null,null,null,null,null,"$110k","AP","Check_SuppLife"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!C6=\"\",\"\",Supp_Life_STD_LTD_Info!C6)","v":""},null,null,3,null,null,null,null,null,null,null,"$120k","AR","Check_STD"]
[{"$f":"IF(A14=\"\",\"\",\"none\")","v":""},null,null,4,null,"EE",null,null,null,null,null,"$130k","AS","Check_LTD"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!C7=\"\",\"\",Supp_Life_STD_LTD_Info!C7)","v":""},null,null,5,null,"SP",null,null,null,null,null,"$140k","AZ","EffectiveDate"]
[{"$f":"IF(A16=\"\",\"\",\"none\")","v":""},null,null,6,null,"CH",null,null,null,null,null,"$150k","CA","Check_HT"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!C8=\"\",\"\",Supp_Life_STD_LTD_Info!C8)","v":""},null,null,7,null,"WV",null,null,null,null,null,"$160k","CO","Check_HoursWorked"]
[{"$f":"IF(A18=\"\",\"\",\"none\")","v":""},null,null,8,null,"__",null,null,null,null,null,"$170k","CT","Check_DependentSSN"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!C9=\"\",\"\",Supp_Life_STD_LTD_Info!C9)","v":""},null,null,9,null,"ST",null,null,null,null,null,"$180k","DC","Check_DependentAge"]
[{"$f":"IF(A20=\"\",\"\",\"none\")","v":""},null,null,10,null,"CB",null,null,null,null,null,"$190k","DE","MaxDepAge",25]
[{"$f":"IF(Supp_Life_STD_LTD_Info!C10=\"\",\"\",Supp_Life_STD_LTD_Info!C10)","v":""},null,null,11,null,"DP",null,null,null,null,null,"$200k","FL"]
[{"$f":"IF(A22=\"\",\"\",\"none\")","v":""},null,null,null,null,"HM",null,null,null,null,null,"$210k","FM","Product","Indicator"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!C11=\"\",\"\",Supp_Life_STD_LTD_Info!C11)","v":""},null,null,null,null,"HP",null,null,null,null,null,"$220k","GA","Medical"]
[null,null,null,null,null,"MC",null,null,null,null,null,"$230k","GU","Dental"]
[{"$f":"IF(A25=\"\",\"\",\"none\")","v":""},{"$f":"IF(B25=\"\",\"\",\"none\")","v":""},null,null,null,"RR",null,null,null,null,null,"$240k","HI","Vision"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!F5=\"\",\"\",Supp_Life_STD_LTD_Info!F5)","v":""},{"$f":"IF(Supp_Life_STD_LTD_Info!H5=\"\",\"\",Supp_Life_STD_LTD_Info!H5)","v":""},null,null,null,"SS",null,null,null,null,null,"$250k","IA","EmployeeLife"]
[{"$f":"IF(A27=\"\",\"\",\"none\")","v":""},{"$f":"IF(B27=\"\",\"\",\"none\")","v":""},{"$f":"IF(CONCATENATE(Supp_Life_STD_LTD_Info!C5,Supp_Life_STD_LTD_Info!F5,Supp_Life_STD_LTD_Info!H5)=\"\",\"\",Supp_Life_STD_LTD_Info!B5)","v":""},null,null,null,null,null,null,null,null,"$260k","ID","DepLife"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!F6=\"\",\"\",Supp_Life_STD_LTD_Info!F6)","v":""},{"$f":"IF(Supp_Life_STD_LTD_Info!H6=\"\",\"\",Supp_Life_STD_LTD_Info!H6)","v":""},{"$f":"IF(CONCATENATE(Supp_Life_STD_LTD_Info!C6,Supp_Life_STD_LTD_Info!F6,Supp_Life_STD_LTD_Info!H6)=\"\",\"\",Supp_Life_STD_LTD_Info!B6)","v":""},null,null,null,null,null,null,null,null,"$270k","IL","MedPlans"]
[{"$f":"IF(A29=\"\",\"\",\"none\")","v":""},{"$f":"IF(B29=\"\",\"\",\"none\")","v":""},{"$f":"IF(CONCATENATE(Supp_Life_STD_LTD_Info!C7,Supp_Life_STD_LTD_Info!F7,Supp_Life_STD_LTD_Info!H7)=\"\",\"\",Supp_Life_STD_LTD_Info!B7)","v":""},null,null,null,null,null,null,null,null,"$280k","IN","DenPlans"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!F7=\"\",\"\",Supp_Life_STD_LTD_Info!F7)","v":""},{"$f":"IF(Supp_Life_STD_LTD_Info!H7=\"\",\"\",Supp_Life_STD_LTD_Info!H7)","v":""},{"$f":"IF(CONCATENATE(Supp_Life_STD_LTD_Info!C8,Supp_Life_STD_LTD_Info!F8,Supp_Life_STD_LTD_Info!H8)=\"\",\"\",Supp_Life_STD_LTD_Info!B8)","v":""},null,null,null,null,null,null,null,null,"$290k","KS","LifeType"]
[{"$f":"IF(A31=\"\",\"\",\"none\")","v":""},{"$f":"IF(B31=\"\",\"\",\"none\")","v":""},{"$f":"IF(CONCATENATE(Supp_Life_STD_LTD_Info!C9,Supp_Life_STD_LTD_Info!F9,Supp_Life_STD_LTD_Info!H9)=\"\",\"\",Supp_Life_STD_LTD_Info!B9)","v":""},null,null,null,null,null,null,null,null,"$300k","KY"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!F8=\"\",\"\",Supp_Life_STD_LTD_Info!F8)","v":""},{"$f":"IF(Supp_Life_STD_LTD_Info!H8=\"\",\"\",Supp_Life_STD_LTD_Info!H8)","v":""},{"$f":"IF(CONCATENATE(Supp_Life_STD_LTD_Info!C10,Supp_Life_STD_LTD_Info!F10,Supp_Life_STD_LTD_Info!H10)=\"\",\"\",Supp_Life_STD_LTD_Info!B10)","v":""},null,null,null,null,null,null,null,null,"$310k","LA"]
[{"$f":"IF(A33=\"\",\"\",\"none\")","v":""},{"$f":"IF(B33=\"\",\"\",\"none\")","v":""},{"$f":"IF(CONCATENATE(Supp_Life_STD_LTD_Info!C11,Supp_Life_STD_LTD_Info!F11,Supp_Life_STD_LTD_Info!H11)=\"\",\"\",Supp_Life_STD_LTD_Info!B11)","v":""},null,null,null,null,null,null,null,null,"$320k","MA"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!F9=\"\",\"\",Supp_Life_STD_LTD_Info!F9)","v":""},{"$f":"IF(Supp_Life_STD_LTD_Info!H9=\"\",\"\",Supp_Life_STD_LTD_Info!H9)","v":""},null,null,null,null,null,null,null,null,null,"$330k","MD"]
[{"$f":"IF(A35=\"\",\"\",\"none\")","v":""},{"$f":"IF(B35=\"\",\"\",\"none\")","v":""},null,null,null,null,null,null,null,null,null,"$340k","ME"]
[{"$f":"IF(Supp_Life_STD_LTD_Info!F10=\"\",\"\",Supp_Life_STD_LTD_Info!F10)","v":""},{"$f":"IF(Supp_Life_STD_LTD_Info!H10=\"\",\"\",Supp_Life_STD_LTD_Info!H10)","v":""},null,null,null,null,null,null,null,null,null,"$350k","MH"]
[null,null,null,null,null,null,null,null,null,null,null,"$360k","MI"]
[null,null,null,null,null,null,null,null,null,null,null,"$370k","MN"]
[null,null,null,null,null,null,null,null,null,null,null,"$380k","MO"]
[null,null,null,null,null,null,null,null,null,null,null,"$390k","MP"]
[null,null,null,null,null,null,null,null,null,null,null,"$400k","MS"]
[null,null,null,null,null,null,null,null,null,null,null,"$410k","MT"]
[null,null,null,null,null,null,null,null,null,null,null,"$420k","NC"]
[null,null,null,null,null,null,null,null,null,null,null,"$430k","ND"]
[null,null,null,null,null,null,null,null,null,null,null,"$440k","NE"]
[null,null,null,null,null,null,null,null,null,null,null,"$450k","NH"]
[null,null,null,null,null,null,null,null,null,null,null,"$460k","NJ"]
[null,null,null,null,null,null,null,null,null,null,null,"$470k","NM"]
[null,null,null,null,null,null,null,null,null,null,null,"$480k","NV"]
[null,null,null,null,null,null,null,null,null,null,null,"$490k","NY"]
[null,null,null,null,null,null,null,null,null,null,null,"$500k","OH"]
[null,null,null,null,null,null,null,null,null,null,null,"--","OK"]
[null,null,null,null,null,null,null,null,null,null,null,"1x Salary","OR"]
[null,null,null,null,null,null,null,null,null,null,null,"2x Salary","PA"]
[null,null,null,null,null,null,null,null,null,null,null,null,"PR"]
[null,null,null,null,null,null,null,null,null,null,null,null,"PW"]
[null,null,null,null,null,null,null,null,null,null,null,null,"RI"]
[null,null,null,null,null,null,null,null,null,null,null,null,"SC"]
[null,null,null,null,null,null,null,null,null,null,null,null,"SD"]
[null,null,null,null,null,null,null,null,null,null,null,null,"TN"]
[null,null,null,null,null,null,null,null,null,null,null,null,"TX"]
[null,null,null,null,null,null,null,null,null,null,null,null,"UT"]
[null,null,null,null,null,null,null,null,null,null,null,null,"VA"]
[null,null,null,null,null,null,null,null,null,null,null,null,"VI"]
[null,null,null,null,null,null,null,null,null,null,null,null,"VT"]
[null,null,null,null,null,null,null,null,null,null,null,null,"WA"]
[null,null,null,null,null,null,null,null,null,null,null,null,"WI"]
[null,null,null,null,null,null,null,null,null,null,null,null,"WV"]
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{"sheet":"MUGS template","index":2,"n_rows":1,"n_cols":10,"rows_kept":1,"cut":false,"hidden":true,"merged":[]}
["EEID*","* Last Name","* First Name","* Date of Birth (MM/DD/YYYY)","* Sex","ContractTier*","* Relationship","Feet","Inches","Weight"]

{"sheet":"CAT template","index":3,"n_rows":1,"n_cols":8,"rows_kept":1,"cut":false,"hidden":true,"merged":[]}
["EEID","SSN","Last Name","First Name","Sex","Date of Birth (MM/DD/YYYY)","ZipCode","Relationship"]

{"sheet":"eServices Template template old","index":4,"n_rows":4,"n_cols":20,"rows_kept":4,"cut":false,"hidden":true,"merged":[[2,16,3,16],[2,17,3,17],[2,19,3,19],[2,1,2,2],[2,3,3,3],[2,4,2,8],[2,9,2,13],[2,14,3,14],[2,15,3,15]]}
[]
[null,"* Required Field"]
[null,"EMPLOYEE NAME",null,"SEX*","EMPLOYEE *\n(Enter Age OR DOB)\nDOB can be entered as one column or as individual columns. Refer to the instructional tab for information regarding acceptable formats.",null,null,null,null,"SPOUSE\n(Enter Age OR DOB)\nDOB can be entered as one column or as individual columns. Refer to the instructional tab for information regarding acceptable formats.",null,null,null,null,"NO. \nCHILD\nENR*","EMPLOYMENT STATUS*","ANNUAL SALARY","OUT OF          AREA               OOA information will be ignored for Multi-site groups.","COMPANY            LOCATION ZIP CODE* Location information will be ignored for Single-site groups.","CLASS TYPE"]
[null,"FIRST*","LAST*",null,"AGE","DOB\n(MM/DD/YYYY)","MM","DD","YY","SPOUSE \nAGE","DOB\n(MM/DD/YYYY)","MM","DD","YY",null,null,null,null,"ZIP CODE                           (5-Digits)"]

{"sheet":"eServices Template template new","index":5,"n_rows":4,"n_cols":45,"rows_kept":4,"cut":false,"hidden":true,"merged":[[2,42,2,44],[2,2,2,11],[2,12,2,14],[2,15,2,17],[2,18,2,20],[2,21,2,23],[2,24,2,26],[2,27,2,29],[2,30,2,32],[2,33,2,35],[2,36,2,38],[2,39,2,41]]}
[]
[null,null,"* Required Field"]
[null,"COMPANY            LOCATION ZIP CODE Location information will be ignored for Single-site groups.","EMPLOYEE DETAILS",null,null,null,null,null,null,null,null,null,"SPOUSE\nEnter Age OR DOB only if Spouse is being enrolled, if not, leave it blank.",null,null,"CHILD 1\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 2 \nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 3\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 4\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 5\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 6\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 7\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 8\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 9\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank.",null,null,"CHILD 10\nEnter Age OR DOB only if a child is being enrolled, if not, leave it blank."]
[null,"ZIP CODE*                           (5-Digits)","CLASS TYPE","FIRST NAME*","LAST NAME*","SEX*","AGE*\nEnter Age OR DOB","DOB*\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","EMPLOYMENT STATUS*","ANNUAL SALARY","OUT OF          AREA               OOA information will be ignored for Multi-site groups.","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS","AGE\nEnter Age OR DOB","DOB\n(MM/DD/YYYY)\nEnter Age OR DOB","MEDICARE \nSTATUS"]

{"sheet":"Medical Waivers","index":6,"n_rows":1,"n_cols":5,"rows_kept":1,"cut":false,"hidden":true,"merged":[]}
["* Employee ID/SSN","* Relationship","* Last Name","* First Name","Medical Waiver Reason"]

{"sheet":"Tools","index":7,"n_rows":34,"n_cols":11,"rows_kept":34,"cut":false,"hidden":false,"merged":[[4,7,4,10],[5,8,8,10],[21,6,26,10],[29,8,31,10],[33,8,35,10]]}
["Version 2015.12.15.01"]
[]
[]
[]
[null,null,null,null,null,null,"Group Name:"]
[null,null,null,null,null,null,null,null,"(these fields are optional, here to help you track which group this spreadsheet belongs to)"]
[null,null,null,null,null,null,"Effective Date:"]
[]
[null,null,null,null,null,null,"Tax ID:"]
[]
[]
[]
[null,null,null,null,null,null,null,"Medical","Dental","Vision","Life"]
[null,null,null,null,null,null,"EE-only:"]
[null,null,null,null,null,null,"EE + Spouse:"]
[null,null,null,null,null,null,"EE + Child(ren):"]
[null,null,null,null,null,null,"EE + Family:"]
[null,null,null,null,null,null,"# of Dependents:"]
[]
[]
[]
[null,null,null,null,null,null,"Notes:\n1.  You must have chosen to enable macros when opening this file for these tools to work.\n2.  Set a member's medical coverage to \"N\" for them not to show up on MUW or UeS exports.\n3.  Validation of enrollment information is based on PRIME 2-50 installation rules and field limitations.\n4.  Purple lines on the enrollment form mean that those lines have invalid COB.\n5.  Changes to the enrollment form will delete existing export tabs and clear the census table above.\n6.  See the \"Enrollment Form Explanations\" tab for more info on requirements and best practices.\n7.  See the \"Enrollment Form Explanations\" tab for info on how to fill out fields for L&D products."]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,"This will import a Census sheet into the \n\"New Enrollment Form\" to be used by \nother tools within this spreadsheet"]
[]
[]
[]
[null,null,null,null,null,null,null,null,"This will compare either two Census sheets or\na census sheet and the \"New Enrollment Form\"\nsheet within this spreadsheet "]

{"sheet":"Supp_Life_STD_LTD_Info","index":8,"n_rows":11,"n_cols":9,"rows_kept":11,"cut":false,"hidden":false,"merged":[[1,1,1,8],[2,1,3,1],[2,7,2,8],[2,5,2,6],[2,2,2,4]]}
[]
[null,"Supplemental Life / STD / LTD Information"]
[null,"EE Class","Supplemental Life Plan Information",null,null,"STD Information",null,"LTD Information"]
[null,null,"EE Plans","SP Amount Options","CH Amount Options","Plan","Buy-up available?","Plan","Buy-up available?"]
[null,1]
[null,2]
[null,3]
[null,4]
[null,5]
[null,6]
[null,7]

{"sheet":"Enrollment Form Explanations","index":9,"n_rows":115,"n_cols":3,"rows_kept":115,"cut":false,"hidden":false,"merged":[[93,0,93,1],[94,0,94,1],[97,0,97,1],[53,2,62,3],[0,0,0,1],[13,0,13,1],[90,0,90,1],[92,0,92,1]]}
["ENROLLMENT FORM EXPLANATIONS"]
["General Notes: "]
["Copying & Pasting","If you're going to copy and paste into the spreadsheet from another source, always paste values.  To do this, select the cell or range that you want to paste into, right-click, select \"Paste Special\", and then click on the \"Values\" radio button and click OK.  It's a best practice to do this and never do a normal paste, especially with date fields."]
["Dates","All dates must be between 1900 and 2020 and they will format automatically to the required format."]
["Dependents","Dependent information is required for every field marked by the red asterisk, as well as the Y/N indicators for each line of coverage the group is taking."]
["Drop-Down Menus vs. Typing","Data can be typed into each cell, granted that it matches the drop-down menu options for fields with drop-downs, which are case-sensitive.  Using Caps Lock and selecting from drop-downs where applicable are best practices."]
["Enrollment Forms","The spreadsheet does not take the place of Enrollment Forms (except for standalone specialty business on PRIME), Brokers must still submit them to the HealthPlan, and the Health Plan to Medical Underwriting (MUW).  There is no need to send them into Case Install (CI), if MUW has already been provided copies.  "]
["Info Boxes","Can be moved by dragging them with the curser, if they interfere with data being input."]
["Printing"," Select what you want printed, by holding down Shift and then using the Arrow keys.  Then go to File/Print/Selection (Under \"Print What\" on bottom left of the Print Dialogue box)/OK to PRINT."]
["Required Fields","All fields are required for every member, unless noted otherwise below."]
["Sample Spreadsheet Entry","A sample spreadsheet entry is pasted below and can be printed for reference."]
["\"Tools\" tab","Buttons to validate enrollment tab data for completeness and validity.  Also allows creation of MUGS and CAT census reports, and UeS exports for medical quotes."]
[]
["Sections A through G"]
["Employee ID/SSN","Enter all 9 digits, without dashes.  Every member must have ID/SSN field completed -- in this column, all dependents must use the subscriber's ID/SSN.  Please do not input the dependent's ID/SSN in this field.  Dependent ID numbers must match Employee/Participant’s ID and must be placed on the row directly below the Employee. "]
["Dependent ID/SSN","Enter all 9 digits, without dashes.  Every dependent must have ID/SSN field completed.  In this column, dependents must use their own ID/SSN - do not use the subscriber's ID/SSN."]
["Relationship","EE=Employee, SP=Spouse, CH=Child, WV=Waiver, ST=Student, CB=COBRA, DP=Domestic Partner, HM=Mentally Handicapped, HP=Physically Handicapped, MC=Medicare, RR=Retired, SS=Surviving Spouse"]
["Last Name","No punctuation.  Spaces are allowed.  First names cannot contain Jr, Sr, or the like. Must be added to last name.  25 character limit."]
["First Name","No punctuation.  No spaces.  First names cannot contain Jr, Sr, or the like. Must be added to last name.  14 character limit."]
["Middle Initial","One letter is only accepted - no punctuation, numbers, or spaces."]
["Sex","F=Female, M=Male"]
["Date of Birth","Dates must be between 1900 and 2020 - automatic formatting applies (MM/DD/YYYY)."]
["Height","ONLY REQUIRED FOR NEW UNDERWRITING PROCESS (you will be informed when this applies to your site) - Enter feet and inches.  Round to the nearest inch.  Do not enter height only in inches:  for example, enter 5 feet, 0 inches and NOT 60 inches."]
["Weight","ONLY REQUIRED FOR NEW UNDERWRITING PROCESS (you will be informed when this applies to your site) - Enter weight in pounds"]
["Tobacco","NOT REQUIRED - field is available for potential future use - can be input but will not be validated or installed"]
["Twin","Indicate \"Y\" (yes) for any twins"]
["Street Address","Field maximum of 60 characters long.  Include Apt #, if applicable and use standard abbreviations when possible: St=Street, Ave=Avenue, Rd=Road, etc.  Apt # is to be placed at the end of the address. Allowed characters include alphanumerics, spaces, commas, apostrophes, hyphens, slashes, pound signs, and ampersands.  Not required on dependent rows."]
["City","Letters and spaces only, no punctuation or numbers allowed. Field maximum of 15 characters long.  Use USPS abbreviations whenever possible.  Not required on dependent rows."]
["State","State format will only accept the standard 2 digit state postal abbreviation.  Not required on dependent rows."]
["ZIP","ZIP Code format will only accept the standard 5 digit postal ZIP Code.  Not required on dependent rows."]
["Home Phone","Format will only accept full 10 digit phone numbers, without dashes.  Not required on dependent rows."]
["Work Phone","Optional field - format will only accept full 10 digit phone numbers, without dashes.  Not required on dependent rows."]
["Empolyee Email Address","Optional field - if inputing information - must contain \"@\" and \".\" symbols"]
["Tier","Enter census tier - it will calculate totals in the \"Counts Relation Tier Ancillary\" tab"]
["Hire Date","Dates must be between 1900 and 2020 - automatic formatting applies  (MM/DD/YY).  Not required on dependent rows."]
["Coverage Effective Date","Dates must be between 1900 and 2020 - automatic formatting applies (MM/DD/YY).  Not required on dependent rows."]
["COBRA Begin Date","Effective date of COBRA coverage - automatic formatting applies (MM/DD/YY).  Not required on dependent rows."]
["COBRA End Date","Date member ceased being eligible for COBRA - automatic formatting applies (MM/DD/YY).  Not required on dependent rows."]
["Retire Date (51+ only)","Use this field only if the subscriber is retired. Formatting and validation (1900-2020) both apply.  Not required on dependent rows."]
["Medical Coverage ","Y=Yes (enrolling for coverage), N=No (no coverage), Y-Dual Cov.=Yes, Dual Coverage.  For Dual Option Coverage, please include plan in next column.  Y or N Required for every member including dependents if this line of coverage is offered."]
["Medical Plan","For Dual Option Only, please indicate plan number."]
["PCP","Primary Care Physician (HMO plans only)"]
["Dental Coverage ","Y=Yes (enrolling for coverage), N=No (no coverage); for Dual Option Dental indicate Y (Yes for enrolling) and include plan selection in next column.  Y or N Required for every member including dependents if this line of coverage is offered."]
["Dental Plan","For Dual Option Only, please indicate plan number."]
["PCD","Primary Care Dentist (DHMO plans only)"]
["Vision Coverage","Y=Yes (enrolling for coverage), N=No (no coverage).  Y or N Required for every member including dependents if this line of coverage is offered."]
["PRIME Life Coverage","This field is for standard PRIME life coverage.  Y=Yes (enrolling for coverage), N=No (no coverage).  Required for every employee if this product is offered.  Not required on dependent rows."]
["PRIME Life Coverage Amount","This field is for standard PRIME life coverage.  Indicate Life Coverage amount here, if enrolling.  Not required on dependent rows."]
["Employee Annual Salary","Employees annual salary, needed if Life coverage is based on salary and disability products and also for STD and LTD coverage.  Required for every employee is salary-based life or disability products are offered.  Not required on dependent rows."]
["PRIME Life Occupational Class","This field is for standard PRIME life coverage.  Occupation Class, needed if Life coverage is based on class  Not required on dependent rows."]
["AD&D Amount","Enter amount for AD&D  Not required on dependent rows."]
["Dependent Life","This field is for standard PRIME dependent life coverage.  Y=Yes (enrolling for coverage), N=No (no coverage).  Required for every dependent if employer is offering this line of coverage."]
["Hours Worked","This field is for entering Employee Hours worked - is not required"]
["Supplemental Life / STD / LTD Occupational Class","If the EE is taking Supplemental Life, STD, or LTD coverage, select their class from the dropdown menu in this field.  Field options are driven by the table at the end of the enrollment form.  This selection drives all other Supplemental Life / STD / LTD options.","The Supplemental Life / STD / LTD Information table must be populated before filling out this fields!  See below for instructions!"]
["EE Supplemental Life Plan","If the EE is taking Supplemental Life, select their plan from the dropdown menu in this field."]
["EE Supplemental Life Amount","If the EE is taking Supplemental Life, select their coverage amount from the dropdown menu in this field."]
["Grandfathered EESupp. Life Amount","If the EE is grandfathering their Supplemental Life benefit amount equal to the prior carrier amount, enter the prior carrier amount in this field for only the supplemental Life EE product."]
["SP Supplemental Life Amount","If the SP is taking Supplemental Life, select their coverage amount from the dropdown menu in this field."]
["CH Supplemental Life Amount","If CH are taking Supplemental Life, select their coverage amount from the dropdown menu in this field."]
["STD (Salary) Coverage","If the EE is taking STD Coverage, select the plan from the dropdown menu in this field."]
["STD Buyup?","If the EE is selecting STD Buyup, select \"Yes\" from the dropdown menu in this field."]
["LTD (Salary) Coverage","If the EE is taking LTD Coverage, select the plan from the dropdown menu in this field."]
["LTD Buyup?","If the EE is selecting LTD Buyup, select \"Yes\" from the dropdown menu in this field."]
["COB - Other Medical ","Y=Yes, if members have other medical coverage, N=No coverage.  If \"Y\" for Other Coverage, please indicate applicable dates in the next two date columns.  Please review the dates in Section D.: “Other Medical Coverage.”  If the End date is prior to our Effective date, enter “NO” for COB.  If the End date extends beyond our Effective date, enter “YES” for COB and provide the Start and End dates.  Required for every member including dependents regardless of lines of coverage offered."]
["COB (begin date)","Effective date of other coverage - automatic formatting applies (MM/DD/YY)."]
["COB (end date)","Date member ceased being eligible for other coverage - automatic formatting applies (MM/DD/YY)."]
["AO Coverage","Enter \"Y\" if group enrolled in AO Coverage or \"N\" - field is optional but will default to \"N\" in the load into PRIME"]
["Eligibility Reason"]
["Ineligibility Reason"]
["Primary Coverage Code"]
["Part A Start Date","Dates must be between 1900 and 2020 - automatic formatting applies  (MM/DD/YY).  Not required on dependent rows."]
["Part A End Date","Dates must be between 1900 and 2020 - automatic formatting applies  (MM/DD/YY).  Not required on dependent rows."]
["Part B Start Date","Dates must be between 1900 and 2020 - automatic formatting applies  (MM/DD/YY).  Not required on dependent rows."]
["Part B End","Dates must be between 1900 and 2020 - automatic formatting applies  (MM/DD/YY).  Not required on dependent rows."]
["Part D Start Date","Dates must be between 1900 and 2020 - automatic formatting applies  (MM/DD/YY).  Not required on dependent rows."]
["Part D End Date","Dates must be between 1900 and 2020 - automatic formatting applies  (MM/DD/YY).  Not required on dependent rows."]
["RV Super Group","To be completed by UHC CI - Internal Operations Only"]
["RV Class ID","To be completed by UHC CI - Internal Operations Only"]
["RV SubGroup (Billing)","To be completed by UHC CI - Internal Operations Only"]
["RV Med Network","To be completed by UHC CI - Internal Operations Only"]
["RV Med Product","To be completed by UHC CI - Internal Operations Only"]
["NHP Group Number","To be completed by UHC CI - Internal Operations Only"]
["On Prior Carrier?","Enter \"Y\" if enrolled under prior carrier plan and \"N\" if not enrolled on prior carrier plan."]
["Optum Bank HSA Application","Y indicates that a signed HSA Application Addendum, including SSN, has been received and is retained by the Health Plan/Broker."]
["Medical Waiver Reason","To be completed by Case Install only."]
["Health Transfer (Completed by C.I.)","Select from Drop Down list only"]
["Covered","To be completed by Case Install only."]
["Policy Number","To be completed by Case Install only."]
[]
[]
["Populating the Supplemental Life / STD / LTD Information Table"]
[]
["On the Supp_Life_STD_LTD_Info tab, there's a table for the L&D plans that are being taken by the group:"]
["This table must be filled out before entering Supplemental Life / STD / LTD coverage for any members!\nStep 1:  If the group is taking supplemental life coverage, enter the EE plan for each occupational class into the EE Plans field.\nStep 2:  If the group is taking dependent supplemental life coverage, select the amount option for SP and CH from the dropdown in those fields.\nStep 3:  If the group is taking STD, enter the plan for each occupational class in the Plan field of the STD Information Section.\nStep 4:  For each class taking STD, select whether STD Buy-up is available.\nStep 5:  If the group is taking LTD, enter the plan for each occupational class in the Plan field of the LTD Information Section.\nStep 6:  For each class taking LTD, select whether LTD Buy-up is available."]
["After you've filled out this table, you can select the class to which the EE belongs and then select from dropdowns which products are being taken by that EE and her dependents."]
[]
[]
["The Tools Tab"]
["Open Member Overlay","Opens the Member Overlay.  You can use the overlay to add, change, or delete members and their information.  Actions on the overlay are immediately reflected in the spreadsheet data.  What you enter is examined, cleaned up, and/or rejected after you enter it."]
["Clean Up Enrollment Spreadsheet","Trims text, formats dates, removes invalid characters, converts to upper case, and sorts all the data.  This will be done automatically before any validation is run, when data is imported from a scratch sheet version, or when the overlay is opened."]
["Validate For Case Install","Opens the Options for a Case Install Validation.  We recommend that you do this before submitting to Case Installation."]
["Validate for MUW","Lets you run a validation for MUW.  Choose from MUGS, CAT, or a generic, bare-bones validation."]
["Validate for UeS Quote","Validates the fields necessary to create a medical UeS quote"]
["Remove Validation Column","Removes the validation column from the \"NEW Enrollment Form\" tab if it's there."]
["Create MUGS Census","Creates a MUGS Census.  Validates the data first."]
["Create CAT Census","Creates a CAT Census.  Validates the data first."]
["Export UeS Medical Quote Template","Creates a template for upload into UeS.  Validates the data first."]
["Remove Census Sheets","Removes any MUGS or CAT census that might be open in the workbook."]
["Create Scratch Sheet","Makes a \"scratch sheet\" version of the enrollment spreadsheet with a smaller file size, no validation, and fewer formatting restrictions.  Allows sorting and filtering.  Does not include any validation.  At this time the scratch version is *NOT* accepted by Case Intall or MUW as a substitute for the full version of the enrollment spreadsheet."]
["Import From Scratch Sheet","Imports data from a \"scratch sheet\" version of the enrollment spreadsheet.  Will only work with files generated through the \"Create Scratch Sheet\" tool.  If the format is different, it will not import.  Data will be cleaned up automatically by the \"Clean Up Enrollment Spreadsheet\" tool, but missing or invalid info must be investigated afterward.  It's recommended that you immediately run a validation after import."]
["Import from another NB Spreadsheet","Imports data from another PRIME NB Enrollment Spreadsheet.  Will only work with official, full versions of the PRIME NB Enrollment Spreadsheet.  Handy if you're importing from another version or want to start over fresh with the data in a really \"dirty\" copy of the enrollment spreadsheet."]
["Import from a NICE Enrollment Spreadsheet","Imports data from a NICE Enrollment spreadsheet.  Wil only work with official version of the NICE data sheet."]
["Import from a FACETS Enrollment Spreadsheet","Imports data from a RV or NHP spreadsheet.  Will only work with official version of RV or NHP Spreadsheet.  Used to validate information on RV or NHP Spreadsheet and import and export split information for Dual-Platform submissions"]
["Import an AFLAC Enrollment Spreadsheet","Imports data from an \"Aflac\" Enrollment spreadsheet.  Will only work with predefined Aflac layout."]
["Clear Spreadsheet","This button will clear all information from the NB Enrollment Spreadsheet.  Handy if you recycle your enrollment spreadsheets multiple times."]

{"sheet":"PlanSource MUW Export","index":10,"n_rows":6,"n_cols":78,"rows_kept":6,"cut":false,"hidden":false,"merged":[[3,68,5,68],[3,67,5,67],[3,60,5,60],[3,61,5,61],[3,70,5,70],[3,69,5,69],[3,62,5,62],[3,63,5,63],[3,64,5,64],[3,65,5,65],[3,66,5,66],[3,77,5,77],[3,71,5,71],[3,72,5,72],[3,73,5,73],[3,74,5,74],[3,76,5,76],[3,75,5,75],[3,59,5,59],[3,54,5,54],[3,55,5,55],[3,56,5,56],[3,57,5,57],[3,58,5,58]]}
[]
["PlanSource MUW Export Data",null,null,null,null,null,null,null,null,null,null,null,"PlanSource MUW Export Data",null,null,null,null,null,null,null,null,null,null,null,"PlanSource MUW Export Data                                                                                                                                                                                                                        PlanSource MUW Export Data                                                                                                                                                                                                                        PlanSource MUW Export Data                                                                                                                                                                                                                        PlanSource MUW Export Data"]
["* Required Fields for all Subscribers & Dependents ",null,null,null,null,null,null,null,null,null,null,null,"A. Employee (Subscriber) Information",null,null,null,null,null,null,"B. Employer Section",null,null,null,null,"C. Product Selection",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"D. Other Medical Coverage",null,null,"E. Other",null,null,null,null,null,null,"Medical Underwriting",null,null,null,null,null,null,null,null,"Medical Underwriting"]
[null,null,null,null,null,null,null,null,"Underwriting ONLY !!!!!",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Life coverage amounts exceeding the guarantee issue will not be installed until proof of good health is provided and approved.   Completion of a Group Life and Disability Employee Enrollment form is required if Life exceeds guarantee issue amount.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"* Smoker","Covered by UnitedHealthcare in past 12 months? EE or SP only","Receiving Social Security Disability Insurance? EE Only","Medicare?","Medicare Type? EE and SP only","Medicare Eligibility Reason? EE and SP Only","eSignature Date","Y/N to any serious conditions","Condition 1 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 2 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 3 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 4 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 5 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 6 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 7 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 8 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 9 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","Condition 10 /Diagnosis\nTreatement/Meds\nPhysician's Name\nDates Treated\nPrognosis","etc as needed","etc as needed","etc as needed","etc as needed","etc as needed","etc as needed"]
[null,null,null,null,null,null,null,null,"Height"]
["* Employee ID/SSN","* Dependent ID/SSN","* Relationship","* Last Name","* First Name","* Middle Initial","* Sex","* Date of Birth\n(MM/DD/YYYY)","Feet","Inches","Weight","Twin?","Street Address","City","State","ZIP","Home Phone","Work Phone (Optional)","Tier\n(Optional)\nTotals in Next Tab","Hire Date\n(MM/DD/YY)","Coverage Effective Date\n(MM/DD/YY)","COBRA Begin Date\n(MM/DD/YY)","COBRA End Date\n(MM/DD/YY)","Retire Date (51+ only)\n(MM/DD/YY)","Medical Coverage","Medical Plan\n(Multi-Choice Only)","PCP\n(HMO Only)","Dental Coverage","Dental Plan\n(Dual Option Only)","PCD\n(DHMO Only)","Vision Coverage","PRIME Life Coverage","PRIME Life Coverage Amount","Employee Annual Salary","PRIME Life Occupational Class","AD&D Amount","Dependent Life","Hours Worked","Supplemental Life / STD / LTD Occupational Class","EE Supplemental Life Plan","EE Supplemental Life Amount","Grandfathered EE Supp. Life Amount","SP Supplemental Life Amount","CH Supplemental Life Amount","STD (Salary) Coverage","STD\nBuyup?","LTD (Salary) Coverage","LTD\nBuyup?","* COB - Other Medical ","COB (begin date)\n(MM/DD/YY)","COB (end date)\n(MM/DD/YY)","On Prior Carrier? ","Exante Bank HSA Application","Health Transfer\n(Completed by C.I.)"]

{"sheet":"Counts_Relation_Tier_Ancillary","index":11,"n_rows":15,"n_cols":5,"rows_kept":15,"cut":false,"hidden":false,"merged":[]}
[]
[]
["RELATIONSHIP","COUNT",null,"TIER","COUNT"]
["EE = Employee",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"EE\")","v":0},null,"EE = Employee",{"$f":"COUNTIF('NEW Enrollment Form'!$U$7:$U$3000, \"EE\")","v":0}]
["SP = Spouse",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"SP\")","v":0},null,"ES = Employee+Spouse",{"$f":"COUNTIF('NEW Enrollment Form'!$U$7:$U$3000, \"ES\")","v":0}]
["CH = Child",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"CH\")","v":0},null,"EC = Employee+Child",{"$f":"COUNTIF('NEW Enrollment Form'!$U$7:$U$3000, \"EC\")","v":0}]
["ST = Student",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"ST\")","v":0},null,"F = Family",{"$f":"COUNTIF('NEW Enrollment Form'!$U$7:$U$3000, \"F\")","v":0}]
[null,null,null,"E+1 = Employee+1",{"$f":"COUNTIF('NEW Enrollment Form'!$U$7:$U$3000, \"E+1\")","v":0}]
["CB = Cobra",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"CB\")","v":0}]
["DP = Domestic Partner",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"DP\")","v":0}]
["HM = Mentally Handicapped",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"HM\")","v":0}]
["HP = Physically Handicapped",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"HP\")","v":0},null,"ANCILLARY","COUNT"]
["MC = Medicare",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"MC\")","v":0},null,"Dental  (All Members)",{"$f":"COUNTIF('NEW Enrollment Form'!$AD$7:$AD$3000, \"Y\")","v":0}]
["RR = Retired ",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"RR\")","v":0},null,"Vision  (All Members)",{"$f":"COUNTIF('NEW Enrollment Form'!$AG$7:$AG$3000, \"Y\")","v":0}]
["SS = Surviving Spouse",{"$f":"COUNTIF('NEW Enrollment Form'!$C$7:$C$300, \"SS\")","v":0},null,"Life  (EE Only)",{"$f":"COUNTIF('NEW Enrollment Form'!$AH$7:$AH$3000, \"Y\")","v":0}]

{"sheet":"Utilization","index":12,"n_rows":4,"n_cols":6,"rows_kept":4,"cut":false,"hidden":true,"merged":[]}
[null,"SubscriberAdd","SubscriberDelete","DependentAdd","DependentDelete","MemberChange"]
["Outside",0,0,0,0,0]
["HP",0,0,0,0,0]
["SBCI",0,0,0,0,0]