EEID|*********|*********|James||Carroll|M|12/27/1966
OFFR|*********|12/27/1967|Open Enrollment|01/01/2017|01/01/2017|01/01/2017|12/31/2017|10/15/2016 08:46:23.950000 AM
ELIG|*********|12/27/1967|565|HIGHMARK PPO 80|EE|Employee|Y|73.74|306.20|Y|Y|Y|Y|Y|80.59|Y|N
ELIG|*********|12/27/1967|565|HIGHMARK PPO 80|EE+SP|Employee + Spouse|N|148.23|615.48|Y|Y|Y|Y|Y|80.59|Y|N
ELIG|*********|12/27/1967|565|HIGHMARK PPO 80|EE+CH|Employee + 1 Child|N|148.23|615.48|Y|Y|Y|Y|Y|80.59|Y|N
ELIG|*********|12/27/1967|565|HIGHMARK PPO 80|EE+1+CH|Employee + 2+ Children|N|207.95|863.50|Y|Y|Y|Y|Y|80.59|Y|N
ELIG|*********|12/27/1967|565|HIGHMARK PPO 80|EE+SP+CH|Employee + Spouse + 1 Child|N|207.95|863.50|Y|Y|Y|Y|Y|80.59|Y|N
ELIG|*********|12/27/1967|565|HIGHMARK PPO 80|EE+SP+2+CH|Employee+Spouse + 2+ Children|N|207.95|863.50|Y|Y|Y|Y|Y|80.59|Y|N
ELIG|*********|12/27/1967|566|HIGHMARK PPO 90|EE|Employee|Y|151.93|669.99|Y|Y|Y|Y|Y|81.52|Y|N
ELIG|*********|12/27/1967|566|HIGHMARK PPO 90|EE+SP|Employee + Spouse|N|305.39|1346.75|Y|Y|Y|Y|Y|81.52|Y|N
ELIG|*********|12/27/1967|566|HIGHMARK PPO 90|EE+CH|Employee + 1 Child|N|305.39|1346.75|Y|Y|Y|Y|Y|81.52|Y|N
ELIG|*********|12/27/1967|566|HIGHMARK PPO 90|EE+1+CH|Employee + 2+ Children|N|305.39|1346.75|Y|Y|Y|Y|Y|81.52|Y|N
ELIG|*********|12/27/1967|566|HIGHMARK PPO 90|EE+SP+CH|Employee + Spouse + 1 Child|N|396.31|1921.60|Y|Y|Y|Y|Y|82.90|Y|N
ELIG|*********|12/27/1967|566|HIGHMARK PPO 90|EE+SP+2+CH|Employee+Spouse + 2+ Children|N|396.31|1921.60|Y|Y|Y|Y|Y|82.90|Y|N
COVG|*********|Open Enrollment|01/01/2017|566|HIGHMARK PPO 90|EE|Employee|151.93|669.99|01/01/2017|||||N|||11/04/2016 02:15:25.000000 PM|01/01/2017
OFFR|*********|12/27/1968|Qualifying Event - WORKTERRA change|04/01/2017|04/01/2017|01/01/2017|12/31/2017|04/03/2017 04:47:36.013000 PM
ELIG|*********|12/27/1968|565|HIGHMARK PPO 80|EE|Employee|Y|95.00|500.95|Y|Y|Y|Y|Y|84.06|Y|N
ELIG|*********|12/27/1968|565|HIGHMARK PPO 80|EE+SP|Employee + Spouse|N|172.50|1019.41|Y|Y|Y|Y|Y|85.53|Y|N
ELIG|*********|12/27/1968|565|HIGHMARK PPO 80|EE+CH|Employee + 1 Child|N|172.50|1019.41|Y|Y|Y|Y|Y|85.53|Y|N
ELIG|*********|12/27/1968|565|HIGHMARK PPO 80|EE+1+CH|Employee + 2+ Children|N|240.00|1428.67|Y|Y|Y|Y|Y|85.62|Y|N
ELIG|*********|12/27/1968|565|HIGHMARK PPO 80|EE+SP+CH|Employee + Spouse + 1 Child|N|240.00|1428.67|Y|Y|Y|Y|Y|85.62|Y|N
ELIG|*********|12/27/1968|565|HIGHMARK PPO 80|EE+SP+2+CH|Employee+Spouse + 2+ Children|N|240.00|1428.67|Y|Y|Y|Y|Y|85.62|Y|N
ELIG|*********|12/27/1968|566|HIGHMARK PPO 90|EE|Employee|Y|165.00|498.89|Y|Y|Y|Y|Y|75.15|Y|N
ELIG|*********|12/27/1968|566|HIGHMARK PPO 90|EE+SP|Employee + Spouse|N|320.00|1007.79|Y|Y|Y|Y|Y|75.90|Y|N
ELIG|*********|12/27/1968|566|HIGHMARK PPO 90|EE+CH|Employee + 1 Child|N|320.00|1007.79|Y|Y|Y|Y|Y|75.90|Y|N
ELIG|*********|12/27/1968|566|HIGHMARK PPO 90|EE+1+CH|Employee + 2+ Children|N|410.00|1462.18|Y|Y|Y|Y|Y|78.10|Y|N
ELIG|*********|12/27/1968|566|HIGHMARK PPO 90|EE+SP+CH|Employee + Spouse + 1 Child|N|410.00|1462.18|Y|Y|Y|Y|Y|78.10|Y|N
ELIG|*********|12/27/1968|566|HIGHMARK PPO 90|EE+SP+2+CH|Employee+Spouse + 2+ Children|N|410.00|1462.18|Y|Y|Y|Y|Y|78.10|Y|N
ELIG|*********|12/27/1968|669|Highmark HDHP plan|EE|Employee|Y|115.00|425.03|Y|Y|Y|Y|Y|78.70|Y|N
ELIG|*********|12/27/1968|669|Highmark HDHP plan|EE+SP|Employee + Spouse|N|230.00|850.04|Y|Y|Y|Y|Y|78.70|Y|N
ELIG|*********|12/27/1968|669|Highmark HDHP plan|EE+CH|Employee + 1 Child|N|230.00|850.04|Y|Y|Y|Y|Y|78.70|Y|N
ELIG|*********|12/27/1968|669|Highmark HDHP plan|EE+1+CH|Employee + 2+ Children|N|320.00|1192.07|Y|Y|Y|Y|Y|78.84|Y|N
ELIG|*********|12/27/1968|669|Highmark HDHP plan|EE+SP+CH|Employee + Spouse + 1 Child|N|320.00|1192.07|Y|Y|Y|Y|Y|78.84|Y|N
ELIG|*********|12/27/1968|669|Highmark HDHP plan|EE+SP+2+CH|Employee+Spouse + 2+ Children|N|320.00|1192.07|Y|Y|Y|Y|Y|78.84|Y|N
COVG|*********|Qualifying Event - WORKTERRA change|04/01/2017|566|HIGHMARK PPO 90|EE|Employee|165.00|498.89|04/01/2017|||||N|||04/01/2017 11:58:28.000000 AM|04/01/2017
OFFR|*********|12/28/1967|Employee Data Change|04/14/2017|04/01/2017|01/01/2017|12/31/2017|04/01/2017 11:58:44.373000 AM
COVG|*********|Employee Data Change|04/14/2017||||||||04/30/2017||||||||