{ "document_id": 13522, "page": 9, "width_pt": 792, "height_pt": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 140, "counts_by_type": { "footer": 1, "heading": 1, "table": 1, "table_cell": 137 }, "build_ms": 30, "items": [ { "id": "p9.1", "order": 1, "type": "heading", "bbox": { "l": 35.28, "t": 577.92, "r": 173.76, "b": 554.64 }, "text": "Benefits Grid", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p9.2", "order": 2, "type": "table", "bbox": { "l": 35.04, "t": 548.64, "r": 758.4, "b": 72.16489999999999 }, "text": "", "attrs": { "block_label": "table", "n_rows": 18, "n_cols": 9, "integrity": { "cells_checked": 137, "cells_flagged": 0 } }, "children": [ { "id": "p9.2.1", "order": 3, "type": "table_cell", "bbox": { "l": 67.4269, "t": 537.5482, "r": 128.6335, "b": 520.6502 }, "text": "Plan Options", "attrs": { "row": 0, "col": 0, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p9.2.2", "order": 4, "type": "table_cell", "bbox": { "l": 210.0056, "t": 543.6205, "r": 265.3546, "b": 531.5505 }, "text": "LivingWell CDHP", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p9.2.3", "order": 5, "type": "table_cell", "bbox": { "l": 363.5557, "t": 543.6205, "r": 414.2047, "b": 531.5505 }, "text": "LivingWell PPO", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p9.2.4", "order": 6, "type": "table_cell", "bbox": { "l": 494.3409, "t": 543.6205, "r": 570.6989, "b": 531.5505 }, "text": "LivingWell Basic CDHP", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p9.2.5", "order": 7, "type": "table_cell", "bbox": { "l": 652.2431, "t": 543.6205, "r": 706.4331, "b": 531.5505 }, "text": "LivingWell HDHP", "attrs": { "row": 0, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p9.2.6", "order": 8, "type": "table_cell", "bbox": { "l": 41.22, "t": 523.3132, "r": 214.2227, "b": 497.2059 }, "text": "In-Network\nLifetime Maximum", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.7", "order": 9, "type": "table_cell", "bbox": { "l": 251.0788, "t": 523.3132, "r": 468.6091, "b": 498.26189999999997 }, "text": "Out-of-Network\nUnlimited", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.8", "order": 10, "type": "table_cell", "bbox": { "l": 333.2588, "t": 523.3132, "r": 368.3039, "b": 512.4502 }, "text": "In-Network", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.9", "order": 11, "type": "table_cell", "bbox": { "l": 398.6801, "t": 523.3132, "r": 447.6023, "b": 512.4502 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.10", "order": 12, "type": "table_cell", "bbox": { "l": 480.3976, "t": 523.3132, "r": 515.4427, "b": 512.4502 }, "text": "In-Network", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.11", "order": 13, "type": "table_cell", "bbox": { "l": 544.7388, "t": 523.3132, "r": 593.661, "b": 512.4502 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.12", "order": 14, "type": "table_cell", "bbox": { "l": 624.0464, "t": 523.3132, "r": 659.0915, "b": 512.4502 }, "text": "In-Network", "attrs": { "row": 1, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.13", "order": 15, "type": "table_cell", "bbox": { "l": 692.6451, "t": 523.3132, "r": 741.5673, "b": 512.4502 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.14", "order": 16, "type": "table_cell", "bbox": { "l": 41.22, "t": 494.0689, "r": 53.721, "b": 483.20590000000004 }, "text": "HRA", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.15", "order": 17, "type": "table_cell", "bbox": { "l": 202.885, "t": 492.9979, "r": 272.4754, "b": 484.26189999999997 }, "text": "Single 500; Family 1,000", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.16", "order": 18, "type": "table_cell", "bbox": { "l": 379.7682, "t": 492.9979, "r": 397.9922, "b": 484.26189999999997 }, "text": "No HRA", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.17", "order": 19, "type": "table_cell", "bbox": { "l": 500.1609, "t": 492.9979, "r": 564.8793, "b": 484.26189999999997 }, "text": "Single 250; Family 500", "attrs": { "row": 2, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.18", "order": 20, "type": "table_cell", "bbox": { "l": 620.9031, "t": 492.9979, "r": 737.7719, "b": 484.26189999999997 }, "text": "No HRA. Can use a non-KEHP HSA with this plan.", "attrs": { "row": 2, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.19", "order": 21, "type": "table_cell", "bbox": { "l": 41.22, "t": 476.04769999999996, "r": 97.7922, "b": 465.1847 }, "text": "Annual Deductible", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.20", "order": 22, "type": "table_cell", "bbox": { "l": 178.6606, "t": 479.7579, "r": 214.7398, "b": 461.4595 }, "text": "Single 1,500\\nFamily 2,750", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.21", "order": 23, "type": "table_cell", "bbox": { "l": 257.5006, "t": 479.7579, "r": 293.5798, "b": 461.4595 }, "text": "Single 2,750\\nFamily 5,250", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.22", "order": 24, "type": "table_cell", "bbox": { "l": 332.7419, "t": 479.7579, "r": 368.8211, "b": 461.4595 }, "text": "Single 1,000\\nFamily 1,750", "attrs": { "row": 3, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.23", "order": 25, "type": "table_cell", "bbox": { "l": 405.1019, "t": 479.7579, "r": 441.1811, "b": 461.4595 }, "text": "Single 1,750\\nFamily 3,250", "attrs": { "row": 3, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.24", "order": 26, "type": "table_cell", "bbox": { "l": 479.8806, "t": 479.7579, "r": 515.9598, "b": 461.4595 }, "text": "Single 2,000\\nFamily 3,750", "attrs": { "row": 3, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.25", "order": 27, "type": "table_cell", "bbox": { "l": 551.1606, "t": 479.7579, "r": 587.2398, "b": 461.4595 }, "text": "Single 3,250\\nFamily 6,250", "attrs": { "row": 3, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.26", "order": 28, "type": "table_cell", "bbox": { "l": 622.1254, "t": 479.7579, "r": 661.0126, "b": 461.4595 }, "text": "Single 2,000 ^{{*}}\\nFamily 4,000 ^{{*}}", "attrs": { "row": 3, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.27", "order": 29, "type": "table_cell", "bbox": { "l": 699.0668, "t": 479.7579, "r": 735.146, "b": 461.4595 }, "text": "Single 4,000\\nFamily 8,000", "attrs": { "row": 3, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.28", "order": 30, "type": "table_cell", "bbox": { "l": 41.22, "t": 451.00530000000003, "r": 94.6611, "b": 432.1423 }, "text": "Annual Maximum Out-of-Pocket", "attrs": { "row": 4, "col": 0, "rowspan": 2, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.29", "order": 31, "type": "table_cell", "bbox": { "l": 196.7533, "t": 456.95550000000003, "r": 278.6069, "b": 448.21950000000004 }, "text": "Applies to Medical and Pharmacy", "attrs": { "row": 4, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.30", "order": 32, "type": "table_cell", "bbox": { "l": 366.1647, "t": 456.95550000000003, "r": 411.5959, "b": 448.21950000000004 }, "text": "Applies to Medical", "attrs": { "row": 4, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.31", "order": 33, "type": "table_cell", "bbox": { "l": 491.5933, "t": 456.95550000000003, "r": 573.4469, "b": 448.21950000000004 }, "text": "Applies to Medical and Pharmacy", "attrs": { "row": 4, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.32", "order": 34, "type": "table_cell", "bbox": { "l": 638.4108, "t": 456.95550000000003, "r": 720.2644, "b": 448.21950000000004 }, "text": "Applies to Medical and Pharmacy", "attrs": { "row": 4, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.33", "order": 35, "type": "table_cell", "bbox": { "l": 178.6606, "t": 443.7155, "r": 580.0741, "b": 410.7033 }, "text": "Single 3,000\\nFamily 5,750\nDeductibles and Maximum Out-of-Pocket for In-Network and Out-of-Network providers accumulate separately and do not cross-apply", "attrs": { "row": 5, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.34", "order": 36, "type": "table_cell", "bbox": { "l": 255.7726, "t": 443.7155, "r": 295.3078, "b": 425.4171 }, "text": "Single 5,750\\nFamily 11,250", "attrs": { "row": 5, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.35", "order": 37, "type": "table_cell", "bbox": { "l": 332.7419, "t": 443.7155, "r": 368.8211, "b": 425.4171 }, "text": "Single 3,000\\nFamily 5,750", "attrs": { "row": 5, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.36", "order": 38, "type": "table_cell", "bbox": { "l": 403.3739, "t": 443.7155, "r": 442.9091, "b": 425.4171 }, "text": "Single 5,750\\nFamily 11,250", "attrs": { "row": 5, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.37", "order": 39, "type": "table_cell", "bbox": { "l": 479.8806, "t": 443.7155, "r": 515.9598, "b": 425.4171 }, "text": "Single 4,000\\nFamily 7,750", "attrs": { "row": 5, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.38", "order": 40, "type": "table_cell", "bbox": { "l": 549.4326, "t": 443.7155, "r": 588.9678, "b": 425.4171 }, "text": "Single 7,750\\nFamily 11,250", "attrs": { "row": 5, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.39", "order": 41, "type": "table_cell", "bbox": { "l": 621.8014, "t": 443.7155, "r": 661.3366, "b": 425.4171 }, "text": "Single 8,050\\nFamily 16,100", "attrs": { "row": 5, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.40", "order": 42, "type": "table_cell", "bbox": { "l": 697.3389, "t": 443.7155, "r": 736.8741, "b": 425.4171 }, "text": "Single 16,100\\nFamily 32,200", "attrs": { "row": 5, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.41", "order": 43, "type": "table_cell", "bbox": { "l": 41.22, "t": 402.2453, "r": 81.8901, "b": 391.3823 }, "text": "Co-Insurance", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.42", "order": 44, "type": "table_cell", "bbox": { "l": 179.0323, "t": 405.95550000000003, "r": 214.3683, "b": 387.6571 }, "text": "Plan: 80%\\nMember: 20%", "attrs": { "row": 6, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.43", "order": 45, "type": "table_cell", "bbox": { "l": 257.8723, "t": 405.95550000000003, "r": 293.2083, "b": 387.6571 }, "text": "Plan: 50%\\nMember: 50%", "attrs": { "row": 6, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.44", "order": 46, "type": "table_cell", "bbox": { "l": 333.1136, "t": 405.95550000000003, "r": 368.4496, "b": 387.6571 }, "text": "Plan: 75%\\nMember: 25%", "attrs": { "row": 6, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.45", "order": 47, "type": "table_cell", "bbox": { "l": 405.4736, "t": 405.95550000000003, "r": 440.8096, "b": 387.6571 }, "text": "Plan: 50%\\nMember: 50%", "attrs": { "row": 6, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.46", "order": 48, "type": "table_cell", "bbox": { "l": 480.2523, "t": 405.95550000000003, "r": 515.5883, "b": 387.6571 }, "text": "Plan: 70%\\nMember: 30%", "attrs": { "row": 6, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.47", "order": 49, "type": "table_cell", "bbox": { "l": 551.5323, "t": 405.95550000000003, "r": 586.8683, "b": 387.6571 }, "text": "Plan: 50%\\nMember: 50%", "attrs": { "row": 6, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.48", "order": 50, "type": "table_cell", "bbox": { "l": 623.9011, "t": 405.95550000000003, "r": 659.2371, "b": 387.6571 }, "text": "Plan: 70%\\nMember: 30%", "attrs": { "row": 6, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.49", "order": 51, "type": "table_cell", "bbox": { "l": 699.4385, "t": 405.95550000000003, "r": 734.7745, "b": 387.6571 }, "text": "Plan: 50%\\nMember: 50%", "attrs": { "row": 6, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.50", "order": 52, "type": "table_cell", "bbox": { "l": 41.22, "t": 376.8241, "r": 103.8582, "b": 365.9611 }, "text": "Doctor's Office Visit", "attrs": { "row": 7, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.51", "order": 53, "type": "table_cell", "bbox": { "l": 169.5208, "t": 375.7531, "r": 223.8792, "b": 367.0171 }, "text": "Deductible, then 20%", "attrs": { "row": 7, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.52", "order": 54, "type": "table_cell", "bbox": { "l": 248.3608, "t": 375.7531, "r": 302.7192, "b": 367.0171 }, "text": "Deductible, then 50%", "attrs": { "row": 7, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.53", "order": 55, "type": "table_cell", "bbox": { "l": 332.7098, "t": 383.7531, "r": 368.853, "b": 359.0171 }, "text": "Co-pay:\\n25 PCP\\n50 Specialist", "attrs": { "row": 7, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.54", "order": 56, "type": "table_cell", "bbox": { "l": 395.9621, "t": 375.7531, "r": 450.3205, "b": 367.0171 }, "text": "Deductible, then 50%", "attrs": { "row": 7, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.55", "order": 57, "type": "table_cell", "bbox": { "l": 470.7408, "t": 375.7531, "r": 525.0992, "b": 367.0171 }, "text": "Deductible, then 30%", "attrs": { "row": 7, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.56", "order": 58, "type": "table_cell", "bbox": { "l": 542.0208, "t": 375.7531, "r": 596.3792, "b": 367.0171 }, "text": "Deductible, then 50%", "attrs": { "row": 7, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.57", "order": 59, "type": "table_cell", "bbox": { "l": 614.3896, "t": 375.7531, "r": 668.748, "b": 367.0171 }, "text": "Deductible, then 30%", "attrs": { "row": 7, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.58", "order": 60, "type": "table_cell", "bbox": { "l": 689.9271, "t": 375.7531, "r": 744.2855, "b": 367.0171 }, "text": "Deductible, then 50%", "attrs": { "row": 7, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.59", "order": 61, "type": "table_cell", "bbox": { "l": 41.22, "t": 355.4029, "r": 119.4723, "b": 336.5399 }, "text": "Annual Prescription Drug Maximum Out-of-Pocket", "attrs": { "row": 8, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.60", "order": 62, "type": "table_cell", "bbox": { "l": 209.1447, "t": 350.3319, "r": 266.2151, "b": 341.5959 }, "text": "Combined with Medical", "attrs": { "row": 8, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.61", "order": 63, "type": "table_cell", "bbox": { "l": 332.7419, "t": 355.1131, "r": 368.8211, "b": 336.8147 }, "text": "Single 2,500\\nFamily 5,000", "attrs": { "row": 8, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.62", "order": 64, "type": "table_cell", "bbox": { "l": 403.3739, "t": 355.1131, "r": 442.9091, "b": 336.8147 }, "text": "Single 5,000\\nFamily 10,000", "attrs": { "row": 8, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.63", "order": 65, "type": "table_cell", "bbox": { "l": 503.9847, "t": 350.3319, "r": 561.0551, "b": 341.5959 }, "text": "Combined with Medical", "attrs": { "row": 8, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.64", "order": 66, "type": "table_cell", "bbox": { "l": 650.8022, "t": 350.3319, "r": 707.8726, "b": 341.5959 }, "text": "Combined with Medical", "attrs": { "row": 8, "col": 5, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p9.2.65", "order": 67, "type": "table_cell", "bbox": { "l": 41.22, "t": 333.7667, "r": 96.9192, "b": 303.9013 }, "text": "30-Day Supply\\nTier 1 - Generic\\nTier 2 - Formulary", "attrs": { "row": 9, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.66", "order": 68, "type": "table_cell", "bbox": { "l": 169.5208, "t": 319.1945, "r": 223.8792, "b": 310.4585 }, "text": "Deductible, then 20%", "attrs": { "row": 9, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.67", "order": 69, "type": "table_cell", "bbox": { "l": 248.3608, "t": 319.1945, "r": 302.7192, "b": 310.4585 }, "text": "Deductible, then 50%", "attrs": { "row": 9, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.68", "order": 70, "type": "table_cell", "bbox": { "l": 345.5974, "t": 323.1945, "r": 355.9654, "b": 306.4585 }, "text": "20\\n40", "attrs": { "row": 9, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.69", "order": 71, "type": "table_cell", "bbox": { "l": 417.9574, "t": 323.1945, "r": 428.3254, "b": 306.4585 }, "text": "40\\n80", "attrs": { "row": 9, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.70", "order": 72, "type": "table_cell", "bbox": { "l": 470.7408, "t": 319.1945, "r": 525.0992, "b": 310.4585 }, "text": "Deductible, then 30%", "attrs": { "row": 9, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.71", "order": 73, "type": "table_cell", "bbox": { "l": 542.0208, "t": 319.1945, "r": 596.3792, "b": 310.4585 }, "text": "Deductible, then 50%", "attrs": { "row": 9, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.72", "order": 74, "type": "table_cell", "bbox": { "l": 614.3896, "t": 319.1945, "r": 668.748, "b": 310.4585 }, "text": "Deductible, then 30%", "attrs": { "row": 9, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.73", "order": 75, "type": "table_cell", "bbox": { "l": 689.9271, "t": 319.1945, "r": 744.2855, "b": 310.4585 }, "text": "Deductible, then 50%", "attrs": { "row": 9, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.74", "order": 76, "type": "table_cell", "bbox": { "l": 41.22, "t": 301.5343, "r": 106.2342, "b": 282.6713 }, "text": "90-Day Supply\\n(Retail or Mail Order)", "attrs": { "row": 10, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.75", "order": 77, "type": "table_cell", "bbox": { "l": 169.5208, "t": 296.4633, "r": 223.8792, "b": 287.7273 }, "text": "Deductible, then 20%", "attrs": { "row": 10, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.76", "order": 78, "type": "table_cell", "bbox": { "l": 260.2923, "t": 296.4633, "r": 290.7883, "b": 287.7273 }, "text": "Not Covered", "attrs": { "row": 10, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.77", "order": 79, "type": "table_cell", "bbox": { "l": 345.5974, "t": 300.4633, "r": 355.9654, "b": 283.7273 }, "text": "40\\n80", "attrs": { "row": 10, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.78", "order": 80, "type": "table_cell", "bbox": { "l": 407.8936, "t": 296.4633, "r": 438.3896, "b": 287.7273 }, "text": "Not Covered", "attrs": { "row": 10, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.79", "order": 81, "type": "table_cell", "bbox": { "l": 470.7408, "t": 296.4633, "r": 525.0992, "b": 287.7273 }, "text": "Deductible, then 30%", "attrs": { "row": 10, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.80", "order": 82, "type": "table_cell", "bbox": { "l": 553.9523, "t": 296.4633, "r": 584.4483, "b": 287.7273 }, "text": "Not Covered", "attrs": { "row": 10, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.81", "order": 83, "type": "table_cell", "bbox": { "l": 614.3896, "t": 296.4633, "r": 668.748, "b": 287.7273 }, "text": "Deductible, then 30%", "attrs": { "row": 10, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.82", "order": 84, "type": "table_cell", "bbox": { "l": 701.8585, "t": 296.4633, "r": 732.3545, "b": 287.7273 }, "text": "Not Covered", "attrs": { "row": 10, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.83", "order": 85, "type": "table_cell", "bbox": { "l": 41.22, "t": 265.965, "r": 120.4896, "b": 236.69600000000003 }, "text": "Covered Services\nPreventive Care Office Visits", "attrs": { "row": 11, "col": 0, "rowspan": 1, "colspan": 9, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.84", "order": 86, "type": "table_cell", "bbox": { "l": 41.22, "t": 232.00650000000002, "r": 112.4656, "b": 214.7985 }, "text": "Well-baby, well-child visits, as recommended", "attrs": { "row": 12, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.85", "order": 87, "type": "table_cell", "bbox": { "l": 188.7522, "t": 227.7745, "r": 204.6482, "b": 219.0385 }, "text": "100%", "attrs": { "row": 12, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.86", "order": 88, "type": "table_cell", "bbox": { "l": 248.3608, "t": 227.7745, "r": 302.7192, "b": 219.0385 }, "text": "Deductible, then 50%", "attrs": { "row": 12, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.87", "order": 89, "type": "table_cell", "bbox": { "l": 342.8334, "t": 227.7745, "r": 358.7294, "b": 219.0385 }, "text": "100%", "attrs": { "row": 12, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.88", "order": 90, "type": "table_cell", "bbox": { "l": 395.9621, "t": 227.7745, "r": 450.3205, "b": 219.0385 }, "text": "Deductible, then 50%", "attrs": { "row": 12, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.89", "order": 91, "type": "table_cell", "bbox": { "l": 489.9721, "t": 227.7745, "r": 505.8681, "b": 219.0385 }, "text": "100%", "attrs": { "row": 12, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.90", "order": 92, "type": "table_cell", "bbox": { "l": 542.0208, "t": 227.7745, "r": 596.3792, "b": 219.0385 }, "text": "Deductible, then 50%", "attrs": { "row": 12, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.91", "order": 93, "type": "table_cell", "bbox": { "l": 633.6209, "t": 227.7745, "r": 649.5169, "b": 219.0385 }, "text": "100%", "attrs": { "row": 12, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.92", "order": 94, "type": "table_cell", "bbox": { "l": 689.9271, "t": 227.7745, "r": 744.2855, "b": 219.0385 }, "text": "Deductible, then 50%", "attrs": { "row": 12, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.93", "order": 95, "type": "table_cell", "bbox": { "l": 41.22, "t": 210.2081, "r": 128.4896, "b": 187.00330000000002 }, "text": "Adult annual physical exam\nImmunizations, as recommended", "attrs": { "row": 13, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.94", "order": 96, "type": "table_cell", "bbox": { "l": 188.7522, "t": 209.97609999999997, "r": 204.6482, "b": 187.24329999999998 }, "text": "100%\n100%", "attrs": { "row": 13, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.95", "order": 97, "type": "table_cell", "bbox": { "l": 248.3608, "t": 209.97609999999997, "r": 302.7192, "b": 187.24329999999998 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 13, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.96", "order": 98, "type": "table_cell", "bbox": { "l": 342.8334, "t": 209.97609999999997, "r": 358.7294, "b": 187.24329999999998 }, "text": "100%\n100%", "attrs": { "row": 13, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.97", "order": 99, "type": "table_cell", "bbox": { "l": 395.9621, "t": 209.97609999999997, "r": 450.3205, "b": 187.24329999999998 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 13, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.98", "order": 100, "type": "table_cell", "bbox": { "l": 489.9721, "t": 209.97609999999997, "r": 505.8681, "b": 187.24329999999998 }, "text": "100%\n100%", "attrs": { "row": 13, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.99", "order": 101, "type": "table_cell", "bbox": { "l": 542.0208, "t": 209.97609999999997, "r": 596.3792, "b": 187.24329999999998 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 13, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.100", "order": 102, "type": "table_cell", "bbox": { "l": 633.6209, "t": 209.97609999999997, "r": 649.5169, "b": 187.24329999999998 }, "text": "100%\n100%", "attrs": { "row": 13, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.101", "order": 103, "type": "table_cell", "bbox": { "l": 689.9271, "t": 209.97609999999997, "r": 744.2855, "b": 187.24329999999998 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 13, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.102", "order": 104, "type": "table_cell", "bbox": { "l": 41.22, "t": 182.41289999999998, "r": 151.7368, "b": 151.2529 }, "text": "Screenings including Pap smears, and labs, as part of the preventive office visit\nOutpatient Services", "attrs": { "row": 14, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p9.2.103", "order": 105, "type": "table_cell", "bbox": { "l": 188.7522, "t": 178.1809, "r": 204.6482, "b": 169.44490000000002 }, "text": "100%", "attrs": { "row": 14, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.104", "order": 106, "type": "table_cell", "bbox": { "l": 248.3608, "t": 178.1809, "r": 302.7192, "b": 169.44490000000002 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.105", "order": 107, "type": "table_cell", "bbox": { "l": 342.8334, "t": 178.1809, "r": 358.7294, "b": 169.44490000000002 }, "text": "100%", "attrs": { "row": 14, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.106", "order": 108, "type": "table_cell", "bbox": { "l": 395.9621, "t": 178.1809, "r": 450.3205, "b": 169.44490000000002 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.107", "order": 109, "type": "table_cell", "bbox": { "l": 489.9721, "t": 178.1809, "r": 505.8681, "b": 169.44490000000002 }, "text": "100%", "attrs": { "row": 14, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.108", "order": 110, "type": "table_cell", "bbox": { "l": 542.0208, "t": 178.1809, "r": 596.3792, "b": 169.44490000000002 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.109", "order": 111, "type": "table_cell", "bbox": { "l": 633.6209, "t": 178.1809, "r": 649.5169, "b": 169.44490000000002 }, "text": "100%", "attrs": { "row": 14, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.110", "order": 112, "type": "table_cell", "bbox": { "l": 689.9271, "t": 178.1809, "r": 744.2855, "b": 169.44490000000002 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.111", "order": 113, "type": "table_cell", "bbox": { "l": 41.22, "t": 139.37290000000002, "r": 148.4168, "b": 130.1649 }, "text": "Primary Care and Specialist Office Visits", "attrs": { "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.112", "order": 114, "type": "table_cell", "bbox": { "l": 169.5208, "t": 139.1409, "r": 223.8792, "b": 130.4049 }, "text": "Deductible, then 20%", "attrs": { "row": 15, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.113", "order": 115, "type": "table_cell", "bbox": { "l": 248.3608, "t": 139.1409, "r": 302.7192, "b": 130.4049 }, "text": "Deductible, then 50%", "attrs": { "row": 15, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.114", "order": 116, "type": "table_cell", "bbox": { "l": 332.7098, "t": 147.1409, "r": 368.853, "b": 122.4049 }, "text": "Co-pay\\n25 PCP\\n50 Specialist", "attrs": { "row": 15, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.115", "order": 117, "type": "table_cell", "bbox": { "l": 395.9621, "t": 139.1409, "r": 450.3205, "b": 130.4049 }, "text": "Deductible, then 50%", "attrs": { "row": 15, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.116", "order": 118, "type": "table_cell", "bbox": { "l": 470.7408, "t": 139.1409, "r": 525.0992, "b": 130.4049 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.117", "order": 119, "type": "table_cell", "bbox": { "l": 542.0208, "t": 139.1409, "r": 596.3792, "b": 130.4049 }, "text": "Deductible, then 50%", "attrs": { "row": 15, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.118", "order": 120, "type": "table_cell", "bbox": { "l": 614.3896, "t": 139.1409, "r": 668.748, "b": 130.4049 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.119", "order": 121, "type": "table_cell", "bbox": { "l": 689.9271, "t": 139.1409, "r": 744.2855, "b": 130.4049 }, "text": "Deductible, then 50%", "attrs": { "row": 15, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.120", "order": 122, "type": "table_cell", "bbox": { "l": 41.22, "t": 118.3329, "r": 147.8096, "b": 101.12490000000003 }, "text": "LiveHealth Online telehealth for Medical and Behavioral Health", "attrs": { "row": 16, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.121", "order": 123, "type": "table_cell", "bbox": { "l": 188.7522, "t": 114.10090000000002, "r": 204.6482, "b": 105.36489999999998 }, "text": "100%", "attrs": { "row": 16, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.122", "order": 124, "type": "table_cell", "bbox": { "l": 271.0081, "t": 114.10090000000002, "r": 280.0721, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.123", "order": 125, "type": "table_cell", "bbox": { "l": 342.8334, "t": 114.10090000000002, "r": 358.7294, "b": 105.36489999999998 }, "text": "100%", "attrs": { "row": 16, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.124", "order": 126, "type": "table_cell", "bbox": { "l": 418.6094, "t": 114.10090000000002, "r": 427.6734, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.125", "order": 127, "type": "table_cell", "bbox": { "l": 489.9721, "t": 114.10090000000002, "r": 505.8681, "b": 105.36489999999998 }, "text": "100%", "attrs": { "row": 16, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.126", "order": 128, "type": "table_cell", "bbox": { "l": 564.6681, "t": 114.10090000000002, "r": 573.7321, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.127", "order": 129, "type": "table_cell", "bbox": { "l": 637.0369, "t": 114.10090000000002, "r": 646.1009, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.128", "order": 130, "type": "table_cell", "bbox": { "l": 712.5743, "t": 114.10090000000002, "r": 721.6383, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.129", "order": 131, "type": "table_cell", "bbox": { "l": 41.22, "t": 93.13289999999995, "r": 134.5608, "b": 75.92489999999998 }, "text": "Telehealth with provider other than LiveHealth Online", "attrs": { "row": 17, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.130", "order": 132, "type": "table_cell", "bbox": { "l": 169.5208, "t": 88.90089999999998, "r": 223.8792, "b": 80.16489999999999 }, "text": "Deductible, then 20%", "attrs": { "row": 17, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.131", "order": 133, "type": "table_cell", "bbox": { "l": 248.3608, "t": 88.90089999999998, "r": 302.7192, "b": 80.16489999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.132", "order": 134, "type": "table_cell", "bbox": { "l": 332.7098, "t": 96.90089999999998, "r": 368.853, "b": 72.16489999999999 }, "text": "Co-pay\\n25 PCP\\n50 Specialist", "attrs": { "row": 17, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.133", "order": 135, "type": "table_cell", "bbox": { "l": 395.9621, "t": 88.90089999999998, "r": 450.3205, "b": 80.16489999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.134", "order": 136, "type": "table_cell", "bbox": { "l": 470.7408, "t": 88.90089999999998, "r": 525.0992, "b": 80.16489999999999 }, "text": "Deductible, then 30%", "attrs": { "row": 17, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.135", "order": 137, "type": "table_cell", "bbox": { "l": 542.0208, "t": 88.90089999999998, "r": 596.3792, "b": 80.16489999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.136", "order": 138, "type": "table_cell", "bbox": { "l": 614.3896, "t": 88.90089999999998, "r": 668.748, "b": 80.16489999999999 }, "text": "Deductible, then 30%", "attrs": { "row": 17, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p9.2.137", "order": 139, "type": "table_cell", "bbox": { "l": 689.9271, "t": 88.90089999999998, "r": 744.2855, "b": 80.16489999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } } ] }, { "id": "p9.3", "order": 140, "type": "footer", "bbox": { "l": 749.04, "t": 30.48, "r": 757.68, "b": 21.36 }, "text": "9", "attrs": { "block_label": "number" } } ], "excluded_furniture": { "first": [], "last": [] } }