ࡱ> > ? !"#$%'()*+,-./0123456789:;<=Root Entry Fy"Workbook &.MBD00140038  FpeQ"PL]"Ole = -F!Notes!Object 1  FMicrosoft Word Document MSWordDocWord.Document.89qOh+'0HPdx  David Sky  DHHS User Microsoft Excel@|I@=dt@"՜.+,0 P1TableCompObjjObjectPoolPjX"PjX"WordDocument  i8@8 NormalCJ_HaJmH sH tH <A@< Default Paragraph Font  z@@UnknownGz Times New Roman5Symbol3& z Arial"1hr02Q David Sky David SkyM bjbj== " WWl        $A aN00 E            âI  [0      1hP= =!"#$%SummaryInformation( DocumentSummaryInformation8SummaryInformation( DocumentSummaryInformation88Oh+'0p  , 8 DPX`hss David Sky aviavi Normal.dot David Sky1viMicrosoft Word 9.0@V@yI@yI՜.+,0 hp   State of NH  Title @`\p DHHS User Ba= =<7#8X@"1Arial1Arial1Arial1Arial1Arial1 Arial"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)                + ) , *  "  (""@ @ """@ @ + "x""@ @  * " ` Transmittal PolicyTypes $$Notes*Policies, Certificates8F>"څ6в!fw{ש@=څ6в!fw{ש4u=~xT;kQf2{g5F"Y6n !.(L n6fL-]~Z G@JD sdU ߹|3p{R$%(^ XX?3ކRsX`6[r頶`AꕋW/Uŷ̷GlP3{p ;G7 +Y(Ww:lY!V=AcFe-\J'QYA5"Y+F-H+;񁞨B'TX*TBNKsx7;ڠG'.>j's=Cdw94'^&)x-}#&_)&'iϫ\d (%%QܺpxWfJ&{΀~ׯO d0>pL#g?R o G#cD]*4 vwõT_s!fp8]T%YDvmÃh_P$rbIAyGgy{bm=Cx~OL{qrEN$v枈WCj97v;?ucSj#Iy#Ԯab8el9C7^tG3  @@  DB Field Name Company CodeReporting YearDate Fiscal Year EndsContact Person Information First Name Last Name Mailing Address Line 1 Mailing Address Line 2 Mailing Address City- Mailing Address 2-Letter State Abbreviation Mailing Zip Code Voice Phone Number e-mail Address;The entry does not conform to the field's specifications. Invalid Data Entry Data Entry#Enter Data in the shaded areas onlyTable ReferenceCoCode ReportYear FYEndDate ContactCity ContactSTABBRContactAddress1ContactAddress2 ContactZip ContactPhone ContactEmailContactPersonFNContactPersonLNCoverage CategoryMarket Category!Geographic Location (County Code) Policy TypePremiumClaimsEffective MonthsHealth Status Factor Policy ID(Tobacco Use Factor (Indiv Policies Only)Industry Factor (Group Only)Group Size Factor (Group Only)'Geographic Location Factor (Group Only)Network Restrictions IndicatorHospital Cost Sharing IndicatorHospital Cost Sharing AmountHospital CoinsuranceHospital Coinsurance Amount$Prescription Drug Coverage Indicator1Prescription Drug Coverage Cost Sharing Indicator!Prescripton Drug Coverage Maximum!Calendar Year or Lifetime Maximum9Physician and Hospital Cost Sharing Interaction IndicatorMaternity Coverage IndicatorMSA/HAS Indicator&Certificate Holder Geographic Location2Number of Certificate Holders (Enrolled Employees)Number of Covered LivesSum of Membership Factors!Outpatient/ Physician Coinsurance(Outpatient/ Physician Coinsurance Amount'Outpatient/ Physician Cost Sharing Type)Outpatient/ Physician Cost Sharing Amount&Total Number of Employees (Group Only)Base Rate PMPMJ  !  5*CZs @   dMbP?_*+%"??cU} I} ,} K  h ;  ;  ;  ;  ;  ;  ;  ;  ;  ;  ;  ;  ;  ;                                         "j84&&&&&&&&&&>@  7 :, Company CodeInvalid Data EntryEnter the 5 digit NAIC Company Code. Codes with leading zeros must be entered as text, e.g. preced the entry with a quotation mark. TPAs should use their 5 character NH license number. ;The entry does not conform to the field's specifications.  Reporting YearInvald Data EntryCPlease enter the fiscal year for which this report is being made. ;The entry does not conform to the field's specifications.  sh,Date Fiscal Year EndsInvalid Data EntryEnter the date the fiscal year ends using MMDD format. Entries with leading zeros must be entered as text, e.g. preceded by a quotation mark. ;The entry does not conform to the field's specifications.  t f,2-Letter State AbbreviationInvalid Data EntryTEnter the 2-letter US State abbreviation for the contact person's mailing address. ;The entry does not conform to the field's specifications. ry n > Zip CodeInvalid Data EntryEnter either the 5-digit zip code or the 9-digit ZIP+4 code. Do not enter the hyhenation mark. Codes with leading zeros must be entered as text, e.g. preced the entry with a quotation mark. ;The entry does not conform to the field's specifications.   $lVocie Phone NumberInvalid Data EntryEnter the direct dial phone number for the contact person. Extensions should be included. For example, (888)555-1212x600 should be entered as 8885551212600. ;The entry does not conform to the field's specifications. d' ci  @ !#  dMbP?_*+%M\\FILES_NHID\BusinessHP4100 odAXXLetter.HP LaserJet 4100 PCL 62uxeK+q-dca1,N͔a:g2KdA6ʗ0oS,/wʤsN9u~r@xmI@)Zb-)F !(M v"@J1Ȝb/+aȄMH2g,}h:`POfځlC! kdAڦRFTC|6;/{fp)II>)FA}!}'"Cb4@NX\h#1*h GWƑhrΚcs?6MymzV$DYwvQkm9Hp(NW;t#tBōxx!+G19x߄erHeW2h_<Md_I"dXX??U}  } I } m } m }  } } } I } } } I }   "  , > ? < = - . / 0 1 2 3 4 5 6 7 A>@  7 @ v)  dMbP?_*+%M\\FILES_NHID\BusinessHP4100 odAXXLetter.HP LaserJet 4100 PCL 62{xeMK[aѼZ?֪(D쭑E AZ-$`4"~d.,.*n B]Mm0:3Ù9<@pJ n[ŭR!/ Y))R\56ZvP;QX7`.$lDT9NRyXCàC?H܇A1S0OewHhWH:No) ǰbwbA0I†= {a>l?}nsauZ]Y֍4uzM@sGZeoLzn.\-Tj\. WJh 3Q:Qz>p#YR^ӳ`ɵ!!Md_I"dXX??U( 5% |  BA ?AA@?0 ]N`( $GWord.Document.88>@  7 @ +,  dMbP?_*+%" ??U}  }  }     '  ! " # $ % @ + ) & * (>@  7 @ -\.  dMbP?_*+%" ??U}  }  } I  ' 8 9 : ;Z>@7 Xl t|  State of NH  Transmittal PolicyTypesNotes Policies Certificates  Worksheets FMicrosoft Excel WorksheetBiff8Excel.Sheet.89qCompObj f