{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["Coversheet","Do not use","Census","Census Instructions","Sample","ATNE Calculator"],"not_rendered":{"charts":0,"images":4,"macros":1,"external_links":0,"defined_names":17,"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":"Coversheet","index":0,"n_rows":43,"n_cols":9,"rows_kept":43,"cut":false,"hidden":false,"merged":[[26,4,26,9],[25,4,25,9],[12,5,12,9],[34,5,34,6],[35,3,35,9],[17,4,17,9],[19,4,19,9],[34,2,34,4],[1,2,1,3],[13,4,13,5],[15,4,15,5],[14,7,14,8],[8,6,8,9],[13,7,13,9],[15,7,15,9],[1,4,1,6],[3,4,3,5],[5,4,5,5],[0,0,0,10],[18,4,18,5],[18,6,18,7],[18,8,18,9],[6,0,16,0],[17,0,26,0],[10,4,10,9],[11,4,11,5],[3,2,3,3],[9,4,9,9],[23,4,23,9],[24,4,24,9],[1,0,5,0],[20,4,20,9],[21,4,21,5],[2,4,2,9],[37,0,41,0],[42,0,49,0],[30,2,30,3],[27,4,27,9],[28,2,28,3],[29,2,29,3],[33,0,36,0],[27,0,32,0],[32,2,32,9],[33,4,33,9],[31,2,31,3],[43,2,49,9],[38,2,39,6],[40,3,40,9],[39,7,39,8]]}
["AHP: Quote Request Form\n(Complete all fields and submit to emailbox indicated to obtain quote)"]
["Association Information",null,"Please submit to Emailbox address",null,{"$f":"VLOOKUP(E5,'Do not use'!A1:L77,12,FALSE)","v":"centralsub@uhc.com"}]
[null,null,null,"Association Name",{"$f":"VLOOKUP(E5,'Do not use'!A1:L77,2,FALSE)","v":"WMC Employer Pulse – Wholesale & Retail Trade"}]
[null,null,"Association Type                                                                                                                       ",null,{"$f":"VLOOKUP(E5,'Do not use'!A1:L77,3,FALSE)","v":"Old AHP Rules"}]
[null,null,null,"Franchise Code",7950931]
[null,null,null,"AHP Zip Code",{"$f":"VLOOKUP(E5,'Do not use'!A2:M77,4,FALSE)","v":53703}]
["Group Information"]
[null,null,null,"Requested Effective Date"]
[null,null,null,"Sole Proprietor? ","Select from Dropdown"]
[null,null,null,"Group Name"]
[null,null,null," Group Physical Address  "]
[null,null,null,"City  ",null,null,"State  ",null,"Zip  "]
[null,null,null,{"$f":"IF(VLOOKUP(E5,'Do not use'!A1:L77,9,FALSE)=\"Yes\",(VLOOKUP(E5,'Do not use'!A1:L77,11,FALSE)),\"\")","v":""},"Select from Dropdown",{"$f":"IF(E5=7620724,IF(E13=\"No\",\"Group is not eligible for BFF quote through Mutual Med.\",\"\"),\"\")","v":""}]
[]
[null,null,null,"Employer Contribution %",null,"Employee",null,"Dependents"]
[null,null,null,"Group SIC Code  ","Select from Dropdown"]
[]
["Agency and Sales Contact Information"]
[null,null,null,"General Agent",{"$f":"IF(VLOOKUP(E5,'Do not use'!A1:L77,8,FALSE)=\"\",\"\",VLOOKUP(E5,'Do not use'!A1:L77,8,FALSE))","v":""},null,"GA Franchise Code"]
[null,null,null,"Writing Agent  "]
[null,null,null,"Agency Name  "]
[null,null,null,"City  ",null,null,"State  ",null,"Zip  "]
[null,null,null,{"$f":"IF(VLOOKUP(E5,'Do not use'!A1:L77,10,FALSE)=\"Yes\",(VLOOKUP(E5,'Do not use'!A1:L77,11,FALSE)),\"\")","v":""},"No"]
[null,null,null,"Broker Email (Where To Send Quote)  "]
[null,null,null," GA Email (Where To Send Quote)  ",{"$f":"IF(VLOOKUP(E5,'Do not use'!A1:M77,13,FALSE)=\"\",\"\",VLOOKUP(E5,'Do not use'!A1:M77,13,FALSE))","v":""}]
[null,null,null,"UHC Account Executive  "]
[]
["Group Size"]
[null,null,"Average Total Number of (W-2) Employees (ATNE) "]
[null,null,"Total Number of Eligible Employees"]
[null,null,"Total Number of Enrolling Employees"]
[null,null,"Total Number of Valid Waivers"]
[]
["Carrier history"]
[null,null,"Is this group currently covered by UHC or one of its Affiliates? ",null,null,"Select from Dropdown"]
[null,null,null,{"$f":"IF(F35=\"Yes\",\"Please contact your Renewal Representative, do not submit this request for a new business quote.\",\"\")","v":""}]
[]
["Other Required Documents"]
[null,null,"Dependent Level Census in Excel format listing all enrolling members (DOB, Gender, Home Zip, Relationship):"]
[null,null,null,null,null,null,null,"Select from Dropdown"]
[null,null,null,{"$f":"IF(H40=\"No\",\"Dependent Level Census is required, please see the Census tab for template.\",\"\")","v":""}]
[]
["Notes"]

{"sheet":"Do not use","index":1,"n_rows":40,"n_cols":17,"rows_kept":40,"cut":false,"hidden":true,"merged":[]}
["Franchise Code","AHP Name","AHP Type","AHP Zip","First Eff Date","Sole Props Allowed?","GA's Allowed?","GA Name","Group Chamber Enrollment Verification Needed?","Agency Chamber Enrollment Verification Needed?","Chamber Verification Line","RFP Submission Email Address","GA Email Address",null,null,null,"Select from Dropdown"]
["Select Franchise Code","Please select a Franchise Code Below","Please select a Franchise Code Below","Please select a Franchise Code Above","2018-10-01","Yes","Yes",null,"N/A","N/A","N/A","txoksub@uhc.com",null,null,null,null,"Yes"]
[7580724,"West Texas Employer Health Plan","New AHP Rules",79401,"2018-10-01","No","Yes","HPGA, LLC DBA Mutual Med","Yes","Yes","Current Member of Lubbock Chamber of Commerce?","chamberquote@mutualmed.com","chamberquote@mutualmed.com",null,null,null,"No"]
[7620000,"BFF- Texas Children Battling Cancer","New AHP Rules",75080,"2018-11-01","No","Yes",null,"No","No",null,"txoksub@uhc.com"]
[7620025,"BFF- Texas Children Battling Cancer","New AHP Rules",75080,"2018-11-01","No","Yes","Foster Benefit Resources","No","No",null,"rates@fosterbenefits.com","rates@fosterbenefits.com"]
[7620234,"BFF- Texas Children Battling Cancer","New AHP Rules",75080,"2018-11-01","No","Yes","Dallas Insurance Exchange II","No","No",null,"rfp@insxch.com"]
[7620671,"BFF- Texas Children Battling Cancer","New AHP Rules",75080,"2018-11-01","No","Yes","Kilpatrick Companies Ltd","No","No",null,"quotes@kilpatrickcos.com"]
[7620728,"BFF- Texas Children Battling Cancer","New AHP Rules",75080,"2018-11-01","No","Yes","RBG Inc- Houston","No","No",null,"bmiser@rogersbenefit.com"]
[7620898,"BFF- Texas Children Battling Cancer","New AHP Rules",75080,"2018-11-01","No","Yes","Dallas Insurance Exchange","No","No",null,"TBD"]
[7620724,"BFF- Texas Children Battling Cancer","New AHP Rules",75080,"2018-11-01","No","Yes","HPGA, LLC DBA Mutual Med","Yes","No","Is group address in Midland or Ector Counties?","chamberquote@mutualmed.com","chamberquote@mutualmed.com"]
[7600000,"HealthyView East Texas","New AHP Rules",75601,"2018-11-01","No","Yes",null,"Yes","Yes","Current Member of Longview Chamber of Commerce?","txoksub@uhc.com"]
[7600234,"HealthyView East Texas","New AHP Rules",75601,"2018-11-01","No","Yes","Dallas Insurance Exchange II","No","No",null,"rfp@insxch.com"]
[7600025,"HealthyView East Texas","New AHP Rules",75601,"2018-11-01","No","Yes","Foster Benefit Resources","No","No",null,"rates@fosterbenefits.com","rates@fosterbenefits.com"]
[7600728,"HealthyView East Texas","New AHP Rules",75601,"2018-11-01","No","Yes","RBG Inc- Houston","No","No",null,"bmiser@rogersbenefit.com"]
[7600671,"HealthyView East Texas","New AHP Rules",75601,"2018-11-01","No","Yes","Kilpatrick Companies Ltd","No","No",null,"quotes@kilpatrickcos.com"]
[7650000,"North Texas Employer Health Plan Cooperative","New AHP Rules",76051,"2018-11-01","No","No",null,"No","No",null,"txoksub@uhc.com"]
[7650025,"North Texas Employer Health Plan Cooperative","New AHP Rules",76051,"2018-11-01","No","Yes","Foster Benefit Resources","No","No",null,"rates@fosterbenefits.com","rates@fosterbenefits.com"]
[7650234,"North Texas Employer Health Plan Cooperative","New AHP Rules",76051,"2018-11-01","No","Yes","Dallas Insurance Exchange II","No","No",null,"rfp@insxch.com"]
[7650671,"North Texas Employer Health Plan Cooperative","New AHP Rules",76051,"2018-11-01","No","Yes","Kilpatrick Companies Ltd","No","No",null,"quotes@kilpatrickcos.com"]
[7650728,"North Texas Employer Health Plan Cooperative","New AHP Rules",76051,"2018-11-01","No","Yes","RBG Inc- Houston","No","No",null,"bmiser@rogersbenefit.com"]
[7640000,"Wisconsin Manufacturing & Commerce Association (WMC)","New AHP Rules",53703,"2019-01-01","No","No",null,"No","No",null,"mflynn@wmc.org"]
[7700000,"Collin County Employers Health Plan Cooperative","New AHP Rules",75013,"2018-11-01","No","No",null,"No","No",null,"txoksub@uhc.com"]
[7700025,"Collin County Employers Health Plan Cooperative","New AHP Rules",75013,"2018-11-01","No","Yes","Foster Benefit Resources","No","No",null,"rates@fosterbenefits.com"]
[7700234,"Collin County Employers Health Plan Cooperative","New AHP Rules",75013,"2018-11-01","No","Yes","Dallas Insurance Exchange II","No","No",null,"rfp@insxch.com"]
[7700671,"Collin County Employers Health Plan Cooperative","New AHP Rules",75013,"2018-11-01","No","Yes","Kilpatrick Companies Ltd","No","No",null,"quotes@kilpatrickcos.com"]
[7700728,"Collin County Employers Health Plan Cooperative","New AHP Rules",75013,"2018-11-01","No","Yes","RBG Inc- Houston","No","No",null,"bmiser@rogersbenefit.com"]
[7730000,"Texas Association Health Plan","New AHP Rules",78205,"2019-01-01","No","No",null,"No","No",null,"txoksub@uhc.com"]
[7730025,"Texas Association Health Plan","New AHP Rules",78205,"2019-01-01","No","Yes","Foster Benefit Resources","No","No",null,"rates@fosterbenefits.com"]
[7730234,"Texas Association Health Plan","New AHP Rules",78205,"2019-01-01","No","Yes","Dallas Insurance Exchange II","No","No",null,"rfp@insxch.com"]
[7730728,"Texas Association Health Plan","New AHP Rules",78205,"2019-01-01","No","Yes","RBG Inc- Houston","No","No",null,"bmiser@rogersbenefit.com"]
[7730671,"Texas Association Health Plan","New AHP Rules",78205,"2019-01-01","No","Yes","Kilpatrick Companies Ltd","No","No",null,"quotes@kilpatrickcos.com"]
[7910000,"Texas Sign Association","Old AHP Rules",77802,"2019-09-01","No","No",null,"No","No",null,"txoksub@uhc.com"]
[7910234,"Texas Sign Association","Old AHP Rules",77802,"2019-09-01","No","Yes","Dallas Insurance Exchange II","No","No",null,"rfp@insxch.com"]
[7910025,"Texas Sign Association","Old AHP Rules",77802,"2019-09-01","No","Yes","Foster Benefit Resources","No","No",null,"rates@fosterbenefits.com","rates@fosterbenefits.com"]
[7910728,"Texas Sign Association","Old AHP Rules",77802,"2019-09-01","No","Yes","RBG Inc- Houston","No","No",null,"bmiser@rogersbenefit.com"]
[7910671,"Texas Sign Association","Old AHP Rules",77802,"2019-09-01","No","Yes","Kilpatrick Companies Ltd","No","No",null,"quotes@kilpatrickcos.com"]
[7910724,"Texas Sign Association","Old AHP Rules",77802,"2019-09-01","No","Yes","HPGA, LLC DBA Mutual Med","No","No",null,"quote@mutualmed.com"]
[7920000,"Printers Industries Midwest (PIM)","Old AHP Rules",55345,"2020-01-01","No","No",null,"Yes","No","Current Member of PIM?","PIMUHC@uhc.com"]
[7950931,"WMC Employer Pulse – Wholesale & Retail Trade","Old AHP Rules",53703,"2019-10-01","No","No",null,"No","No",null,"centralsub@uhc.com"]
[7951931,"WMC Employer Pulse – Manufacturing","Old AHP Rules",53703,"2019-10-01","No","No",null,"No","No",null,"centralsub@uhc.com"]

{"sheet":"Census","index":2,"n_rows":425,"n_cols":10,"rows_kept":425,"cut":false,"hidden":false,"merged":[[2,9,3,9],[1,5,1,8],[2,2,2,8],[5,0,6,0],[2,0,3,0],[2,1,3,1]]}
[]
["Member-Level Census"]
["Internal Use Only","Auto Populated","These yellow fields must be completed for all members (employees, spouses and children)",null,null,null,null,null,null,"Optional"]
[null,null,"E for Employee          S for Spouse              D for Children","Optional","Optional",null,null,null,"EE for Employee Only                           ES for Employee + Spouse                           EC for Employee + Child(ren)                          F for Family"]
["SEQ","EE ID","REL CODE","LAST NAME","FIRST NAME","DOB","GENDER","ZIP","MED TIER","EE STATUS"]
["Sample",1,"E","Smith","John","1970-06-01","M",45111,"ES ","Active"]
[null,1,"S","Smith","Jane","1972-10-01","F",45111]
[null,{"$f":"IF(C8=\"E\",1,\"\")","v":""}]
[null,{"$f":"IF(C9=\"E\",B8+1,IF(C9=\"S\",B8,IF(C9=\"D\",B8,\"\")))","v":""}]
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{"sheet":"Census Instructions","index":3,"n_rows":8,"n_cols":1,"rows_kept":8,"cut":false,"hidden":false,"merged":[[6,0,6,7],[7,0,7,7],[0,0,0,4],[0,7,0,8],[2,0,2,7],[3,0,3,7],[5,0,5,7]]}
["Underwritten Quote: \n51-350 Eligible Subscribers"]
[]
["Important Instructions"]
["1. All fields are required, unless otherwise indicated."]
["2. Census must include all subscribers, spouses, and children who are eligible to enroll as of the effective date."]
["3. Dependents must be grouped immediately underneath the Subscriber to whom they are related."]
["4. Names, if provided, should not include middle initials or suffixes."]
["5. Census must include the home zip code for every employee and dependent."]

{"sheet":"Sample","index":4,"n_rows":718,"n_cols":1,"rows_kept":718,"cut":false,"hidden":false,"merged":[]}
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[5011]
[5012]
[5013]
[5014]
[5015]
[5016]
[5017]
[5018]
[5019]
[5020]
[5021]
[5022]
[5023]
[5024]
[5025]
[5026]
[5027]
[5028]
[5029]
[5030]
[5031]
[5032]
[5033]
[5034]
[5035]
[5036]
[5037]
[5038]
[5039]
[5040]
[5041]
[5042]
[5043]
[5044]
[5045]
[5046]
[5047]
[5048]
[5049]
[5050]
[5051]
[5052]
[5053]
[5054]
[5055]
[5056]
[5057]
[5058]
[5059]
[5060]
[5061]
[5062]
[5063]
[5064]
[5065]
[5066]
[5067]
[5068]
[5069]
[5070]
[5071]
[5072]
[5073]
[5074]
[5075]
[5076]
[5077]
[5078]
[5079]
[5080]
[5081]
[5082]
[5083]
[5084]
[5085]
[5086]
[5087]
[5088]
[5089]
[5090]
[5091]
[5092]
[5093]
[5094]
[5095]
[5096]
[5097]
[5098]
[5099]
[5111]
[5112]
[5113]
[5114]
[5115]
[5116]
[5117]
[5118]
[5119]
[5121]
[5122]
[5123]
[5124]
[5125]
[5126]
[5127]
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{"sheet":"ATNE Calculator","index":5,"n_rows":23,"n_cols":8,"rows_kept":23,"cut":false,"hidden":false,"merged":[[20,1,20,7],[22,1,26,7],[2,1,2,7],[0,1,0,7],[14,1,14,7],[16,1,16,7],[18,1,18,7]]}
[null,"Average Total Number of Employees Calculator"]
[]
[null,"Enter the total number of all employees on payroll during the last day of each month in the previous calendar year.  (Ex. 10/1/18 effective date should use 2017 calendar year employee counts below)\nFor groups in business less than one year, enter the months the group has been in business.\nInclude full-time, part-time, seasonal, and eligible owners."]
[]
[]
[null,"***Fill out green shaded answer boxes***","Jan","Feb","Mar","Apr","May","Jun"]
[null,"Total Number of Employees (Monthly)"]
[null,null,{"$f":"IF(OR(C7=\"\",C7=0),0,1)","v":0},0,0,0,0,0]
[null,null,"Jul","Aug","Sept","Oct","Nov","Dec"]
[null,"Total Number of Employees (Monthly)"]
[null,null,{"$f":"IF(OR(C10=\"\",C10=0),0,1)","v":0},0,0,0,0,0]
[null,"Average Total Number of Employees",{"$f":"IF(ISERROR(SUM(C7:H7,C10:H10)/SUM(C8:H8,C11:H11)),\"\",SUM(C7:H7,C10:H10)/SUM(C8:H8,C11:H11))","v":""}]
[]
[]
[null,"-The ATNE count should include all employees employed by the group during the year in question, including full-time, part-time, and seasonal workers, as well as those who do not qualify for medical coverage.  Generally, inviduals receiving a W-2 qualify as \"employees\" whereas those who receive a 1099 statement are not employees (but independent contractors) and may be excluded; however, it is an employer's obligation to determine who their employees are."]
[]
[null,"-The ATNE count includes owners and partners who may not always get W-2's."]
[]
[null,"-Using whole numbers only, the employer should total the number of employees at the end of each month in the year being requested for ATNE calculation."]
[]
[null,"-The monthly totals for the full year should be added together and that total divided by the number of months in which the employer was in business for that calendar year.  For most employers, this will be 12 months."]
[]
[null,"DISCLAIMER:  This Tool is a calculator provided for informational purposes only.  Use of this tool is not intended as legal and/or tax advice and outcomes should not be considered determinative in any particular case.  Calculations for the Employer mandate are complex.  Employers and/or brokers need to consult their legal and tax advisors to determine applicability of the mandate and to determine their available options."]