5-Attachment E - COA Medical Membership 09-24-2026.xlsx

XLSX spreadsheet 256 KB Posted Oct 13, 2026

Attached to: 2027 Stop Loss Insurance Policy
Solicitation number: RFP 200-27 MRH
Issued by: Orange County, Texas

About this file

Written by GovTribe AI · Oct 15, 2026

This is a medical membership cost analysis spreadsheet supporting the City of Amarillo's 2027 Stop Loss Insurance Policy procurement. The document provides detailed enrollment and cost projections for the city's health plan membership, serving as financial baseline data for the stop loss insurance solicitation. The spreadsheet contains member counts broken down by category (employee, spouse, and dependent classifications), monthly premium calculations, and aggregate cost figures necessary for insurance carriers to develop competitive bid proposals. This supporting documentation enables prospective vendors to understand the city's covered population size and anticipated claims exposure for the upcoming plan year.

The cost analysis spreadsheet functions as a critical underwriting tool for stop loss insurance evaluation, allowing bidders to structure their proposals based on the city's actual membership composition and projected healthcare costs. The data provides transparency regarding the city's employee population structure and premium obligations, facilitating accurate risk assessment by insurance carriers. This attachment supports the procurement process by establishing clear parameters for insurance coverage requirements and enabling vendors to calculate appropriate deductible levels, aggregate limits, and premium rates based on documented membership and cost information specific to the City of Amarillo's workforce.

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Other files

File	Type	Posted
2-2. Stop Loss RFP for 2027 Scope of Work.pdf	PDF	Oct 13, 2026
9-Attachment L - 2025 ACTIVE MEDICAL PLAN 1 BOOKLET.PDF	PDF	Oct 13, 2026
20-Attachment R - CoA 2026 Stop Loss Policy.pdf	PDF	Oct 13, 2026
10-01. RFP 200-27 MRH Notice to Bidders.pdf	PDF	Oct 13, 2026
17-Attachment K - 2025 ACTIVE MEDICAL PLAN 2 SCHEDULE OF BENEFITS.PDF	PDF	Oct 13, 2026
19-Attachment F - CoA MedRx Claims Experience 08-2026.pdf	PDF	Oct 13, 2026
1-Attachment A - Respondent Information and Signature Page.pdf	PDF	Oct 13, 2026
13-Attachment O - 2025 RETIREES MEDICAL PLAN 2 BOOKLET.PDF	PDF	Oct 13, 2026
6-Attachment J - 2025 ACTIVE MEDICAL PLAN 1 SCHEDULE OF BENEFITS.PDF	PDF	Oct 13, 2026
21-Attachment Q - CoA De-ID High-Cost Claimants 08-2026.pdf	PDF	Oct 13, 2026
12-Attachment I - 2025 RETIREES SCHEDULE OF BENEFITS MEDICAL PLAN 2.PDF	PDF	Oct 13, 2026
15-Attachment M - 2025 ACTIVE MEDICAL PLAN 2 BOOKLET.PDF	PDF	Oct 13, 2026
14-Attachment H - 2025 RETIREES SCHEDULE OF BENEFITS MEDICAL PLAN 1.PDF	PDF	Oct 13, 2026
8-Attachment B - City of Amarillo Vendor Acknowledment Form.pdf	PDF	Oct 13, 2026
4-Attachment S - Certificate of Insurance Requirements Sample.pdf	PDF	Oct 13, 2026
11-08. Attachment C - CEP List Revised 10.03.2024 .pdf	PDF	Oct 13, 2026
18-Attachment P - PRESCRIPTION BENEFIT COVERAGE 01.01.2026.pdf	PDF	Oct 13, 2026
7-Attachment D - RFP References Template.pdf	PDF	Oct 13, 2026
3-Attachment G - CoA Stop Loss Questionnaire 2027 Locked.xlsx	XLSX spreadsheet	Oct 13, 2026
16-Attachment N - 2025 RETIREES MEDICAL PLAN 1 BOOKLET.PDF	PDF	Oct 13, 2026

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Enrollment Detail

CITY OF AMARILLO		MEMBER ENROLLMENT
Sub ID De-identified	Relationship	Gender	Birth_Date	Member Zip_Code	Plan Suffix ID	Status	Effective	Billing Tier Level
1	Subscriber	M	1/23/70	79103	Plan 2	Active	1/1/26	EE + Spouse
1	Spouse	F	12/1/67	79103	Plan 2	Active	1/1/26	EE + Spouse
2	Subscriber	M	4/13/72	79118	Plan 1	Active	1/5/26	EE + Children
2	Dependent	F	4/26/05	79109	Plan 1	Active	1/1/26	EE + Children
2	Dependent	F	9/12/06	79109	Plan 1	Active	1/1/26	EE + Children
3	Subscriber	M	4/18/72	79019	Plan 2	Active	1/1/26	Family
3	Spouse	F	3/23/78	79019	Plan 2	Active	1/1/26	Family
3	Dependent	F	11/15/02	79019	Plan 2	Active	1/1/26	Family
4	Subscriber	F	1/17/65	79107	Plan 1	Active	1/1/24	EE only
5	Subscriber	M	12/19/82	79109	Plan 2	Active	1/1/26	Family
5	Spouse	F	8/27/81	79109	Plan 2	Active	1/1/26	Family
5	Dependent	M	1/6/11	79109	Plan 2	Active	1/1/26	Family
5	Dependent	F	7/14/12	79109	Plan 2	Active	1/1/26	Family
6	Subscriber	M	7/18/81	79121	Plan 2	Active	1/1/26	EE + Children
6	Dependent	F	11/22/11	79121	Plan 2	Active	1/1/26	EE + Children
6	Dependent	F	7/17/14	79121	Plan 2	Active	1/1/26	EE + Children
7	Subscriber	F	7/11/57	79124	Plan 2	Active	11/12/24	EE only
8	Subscriber	M	10/29/88	79109	Plan 2	Active	1/5/26	EE + Children
8	Dependent	F	9/20/17	79109	Plan 2	Active	1/5/26	EE + Children
8	Dependent	M	9/9/19	79109	Plan 2	Active	1/5/26	EE + Children
9	Subscriber	M	5/7/83	79106	Plan 1	Active	12/31/23	EE only
10	Subscriber	M	1/12/88	79108	Plan 2	Active	1/1/26	Family
10	Spouse	F	6/14/89	79108	Plan 2	Active	1/1/26	Family
10	Dependent	F	12/25/10	79108	Plan 2	Active	1/1/26	Family
10	Dependent	M	7/25/14	79108	Plan 2	Active	1/1/26	Family
10	Dependent	F	6/23/16	79108	Plan 2	Active	1/1/26	Family
11	Subscriber	M	7/24/65	79119	Plan 2	Active	1/1/26	EE + Spouse
11	Spouse	F	8/27/70	79119	Plan 2	Active	1/1/26	EE + Spouse
12	Subscriber	M	6/9/79	79109	Plan 2	Active	1/5/26	EE only
13	Subscriber	M	7/18/88	79119	Plan 1	Active	4/30/26	EE only
14	Subscriber	M	11/27/78	79109	Plan 1	Active	11/30/25	EE + Children
14	Dependent	F	5/24/01	79109	Plan 1	Active	6/16/25	EE + Children
14	Dependent	F	9/6/11	79109	Plan 1	Active	1/1/24	EE + Children
15	Subscriber	M	9/12/83	79109	Plan 1	Active	1/5/26	EE + Children
15	Dependent	F	11/25/02	79109	Plan 1	Active	4/14/25	EE + Children
15	Dependent	M	8/22/06	79109	Plan 1	Active	4/14/25	EE + Children
15	Dependent	F	3/11/08	79109	Plan 1	Active	4/14/25	EE + Children
15	Dependent	M	7/14/17	79109	Plan 1	Active	1/5/26	EE + Children
15	Dependent	M	12/29/25	79109	Plan 1	Active	1/5/26	EE + Children
16	Subscriber	M	6/6/82	79108	Plan 2	Active	7/20/26	EE + Children
16	Dependent	M	2/8/11	79108	Plan 2	Active	1/1/26	EE + Children
16	Dependent	M	3/27/12	79108	Plan 2	Active	1/1/26	EE + Children
17	Subscriber	M	5/26/84	79119	Plan 2	Active	6/27/25	Family
17	Spouse	F	11/15/85	79119	Plan 2	Active	5/28/24	Family
17	Dependent	M	6/17/10	79119	Plan 2	Active	6/20/25	Family
17	Dependent	M	5/14/15	79119	Plan 2	Active	5/28/24	Family
18	Subscriber	M	12/12/75	79124	Plan 2	Active	9/23/26	Family
18	Spouse	F	7/15/80	79124	Plan 2	Active	1/1/26	Family
18	Dependent	F	12/17/01	79124	Plan 2	Active	1/1/26	Family
18	Dependent	F	1/28/06	79124	Plan 2	Active	1/1/26	Family
19	Subscriber	F	11/19/66	79102	Plan 2	Active	7/14/25	EE only
20	Subscriber	M	7/11/51	79109	Plan 1	Active	1/1/26	EE + Spouse
20	Spouse	F	12/18/54	79109	Plan 1	Active	1/1/26	EE + Spouse
21	Subscriber	M	12/22/80	79106	Plan 2	Active	1/1/26	Family
21	Spouse	F	9/3/80	79106	Plan 2	Active	1/1/26	Family
21	Dependent	M	10/21/10	79106	Plan 2	Active	1/1/26	Family
21	Dependent	M	7/30/18	79106	Plan 2	Active	1/1/26	Family
22	Subscriber	M	9/26/76	79106	Plan 2	Active	6/25/26	Family
22	Spouse	F	7/26/79	79106	Plan 2	Active	1/1/25	Family
22	Dependent	M	9/16/05	79106	Plan 2	Active	1/1/25	Family
22	Dependent	M	8/20/09	79106	Plan 2	Active	1/1/25	Family
23	Subscriber	M	9/25/73	79118	Plan 1	Active	12/8/25	Family
23	Spouse	F	7/28/67	79118	Plan 1	Active	7/23/21	Family
23	Dependent	M	12/16/03	79118	Plan 1	Active	7/23/21	Family
24	Subscriber	M	11/19/80	79118	Plan 1	Active	1/1/26	EE + Children
24	Dependent	M	4/9/07	79118	Plan 1	Active	1/1/26	EE + Children
24	Dependent	F	7/21/12	79118	Plan 1	Active	1/1/26	EE + Children
25	Subscriber	M	6/12/90	79109	Plan 2	Active	1/1/26	EE + Children
25	Dependent	M	9/15/22	79109	Plan 2	Active	1/1/26	EE + Children
25	Dependent	M	5/13/25	79109	Plan 2	Active	1/1/26	EE + Children
26	Subscriber	M	6/21/77	79015	Plan 2	Active	1/1/26	EE + Children
26	Dependent	M	12/7/11	79015	Plan 2	Active	1/1/26	EE + Children
27	Subscriber	M	11/30/83	79092	Plan 1	Active	3/30/26	Family
27	Spouse	F	5/30/86	79092	Plan 1	Active	3/30/26	Family
27	Dependent	F	10/9/06	79092	Plan 1	Active	3/30/26	Family
27	Dependent	M	8/20/11	79092	Plan 1	Active	1/1/26	Family
27	Dependent	M	3/1/13	79092	Plan 1	Active	1/1/26	Family
27	Dependent	M	5/18/17	79092	Plan 1	Active	3/30/26	Family
27	Dependent	M	2/10/23	79092	Plan 1	Active	1/1/26	Family
28	Subscriber	F	11/18/86	79110	Plan 2	Active	3/23/26	EE + Children
28	Dependent	M	7/2/06	79110	Plan 2	Active	3/23/26	EE + Children
28	Dependent	M	7/19/09	79110	Plan 2	Active	11/12/24	EE + Children
29	Subscriber	M	2/14/79	79109	Plan 1	Active	3/24/26	Family
29	Spouse	F	4/9/85	79109	Plan 1	Active	1/1/26	Family
29	Dependent	F	1/9/05	79109	Plan 1	Active	1/1/26	Family
29	Dependent	M	1/18/07	79109	Plan 1	Active	1/1/26	Family
29	Dependent	M	2/11/08	79109	Plan 1	Active	1/1/26	Family
30	Subscriber	M	1/3/72	79118	Plan 2	Active	1/1/24	EE only
31	Subscriber	M	9/28/87	79109	Plan 2	Active	3/28/24	EE + Spouse
31	Spouse	F	11/8/81	79109	Plan 2	Active	3/28/24	EE + Spouse
32	Subscriber	F	11/21/62	79105	Plan 1	Active	12/16/24	EE only
33	Subscriber	M	5/17/67	79110	Plan 1	Active	8/17/26	EE + Spouse
33	Spouse	F	6/3/74	79110	Plan 1	Active	7/1/24	EE + Spouse
34	Subscriber	F	12/17/63	79109	Plan 1	Active	6/29/26	EE + Spouse
34	Spouse	M	4/26/67	79109	Plan 1	Active	1/1/26	EE + Spouse
35	Subscriber	M	1/16/81	79042	Plan 1	Active	1/1/26	Family
35	Spouse	F	8/25/83	79042	Plan 1	Active	8/26/21	Family
35	Dependent	F	3/29/09	79042	Plan 1	Active	1/1/26	Family
36	Subscriber	M	9/6/66	79015	Plan 2	Active	7/27/26	EE + Children
36	Dependent	M	10/28/04	79015	Plan 2	Active	7/27/26	EE + Children
37	Subscriber	M	5/8/84	79105	Plan 2	Active	1/1/26	Family
37	Spouse	F	4/22/90	79105	Plan 2	Active	1/1/26	Family
37	Dependent	M	3/10/06	79105	Plan 2	Active	1/1/26	Family
37	Dependent	M	11/7/09	79105	Plan 2	Active	1/1/26	Family
37	Dependent	F	2/21/17	79105	Plan 2	Active	1/1/26	Family
38	Subscriber	M	6/24/72	79110	Plan 1	Active	3/21/26	EE only
39	Subscriber	M	7/5/72	79111	Plan 2	Active	8/19/25	EE only
40	Subscriber	M	3/25/82	79015	Plan 2	Active	4/10/24	Family
40	Spouse	F	4/11/85	79015	Plan 2	Active	4/10/24	Family
40	Dependent	M	6/15/10	79015	Plan 2	Active	4/10/24	Family
40	Dependent	M	4/23/13	79015	Plan 2	Active	4/10/24	Family
41	Subscriber	M	12/17/80	79109	Plan 1	Active	1/1/26	EE + Children
41	Dependent	M	5/15/13	79109	Plan 1	Active	1/1/26	EE + Children
41	Dependent	F	5/14/16	79109	Plan 1	Active	1/1/26	EE + Children
41	Dependent	F	6/15/21	79109	Plan 1	Active	1/1/26	EE + Children
42	Subscriber	M	5/1/86	79015	Plan 1	Active	1/1/26	Family
42	Spouse	F	11/12/86	79015	Plan 1	Active	1/1/26	Family
42	Dependent	F	8/18/14	79015	Plan 1	Active	1/1/26	Family
42	Dependent	M	7/27/22	79015	Plan 1	Active	1/11/23	Family
42	Dependent	F	7/31/23	79015	Plan 1	Active	11/1/24	Family
43	Subscriber	M	10/20/67	79106	Plan 1	Active	11/21/24	Family
43	Spouse	F	8/21/80	79106	Plan 1	Active	11/21/24	Family
43	Dependent	M	5/26/05	79106	Plan 1	Active	11/21/24	Family
44	Subscriber	M	3/6/59	79124	Plan 2	Active	1/19/26	EE only
45	Subscriber	M	8/13/66	79106	Plan 2	Active	10/7/25	EE only
46	Subscriber	F	10/23/71	79119	Plan 1	Active	1/1/26	EE + Children
46	Dependent	M	1/20/99	79119	Plan 1	Active	1/1/26	EE + Children
46	Dependent	M	11/23/00	79119	Plan 1	Active	1/1/26	EE + Children
47	Subscriber	F	4/10/67	79103	Plan 2	Retiree U65	3/5/26	EE only
48	Subscriber	F	10/26/76	79108	Plan 1	Active	7/4/26	EE + Spouse
48	Spouse	M	10/20/72	79108	Plan 1	Active	7/4/26	EE + Spouse
49	Subscriber	M	12/31/65	79107	Plan 1	Active	1/8/26	EE only
50	Subscriber	M	2/10/82	79015	Plan 2	Active	1/1/24	Family
50	Spouse	F	7/6/85	79015	Plan 2	Active	1/1/24	Family
50	Dependent	M	2/1/10	79015	Plan 2	Active	1/1/24	Family
50	Dependent	M	2/3/14	79015	Plan 2	Active	1/1/24	Family
50	Dependent	M	11/19/15	79015	Plan 2	Active	1/1/24	Family
51	Subscriber	M	7/22/73	79119	Plan 2	Active	2/28/26	EE + Spouse
51	Spouse	F	3/26/67	79119	Plan 2	Active	1/1/26	EE + Spouse
52	Subscriber	M	10/1/82	79119	Plan 1	Active	3/27/26	Family
52	Spouse	F	5/28/86	79119	Plan 1	Active	1/1/26	Family
52	Dependent	M	2/5/09	79119	Plan 1	Active	1/1/26	Family
52	Dependent	F	12/6/12	79119	Plan 1	Active	1/1/26	Family
53	Subscriber	M	10/11/84	79118	Plan 1	Active	7/12/26	EE + Children
53	Dependent	F	5/5/05	79118	Plan 1	Active	8/6/25	EE + Children
53	Dependent	F	4/7/09	79118	Plan 1	Active	8/6/25	EE + Children
54	Subscriber	F	2/5/74	79119	Plan 2	Active	9/2/26	EE only
55	Subscriber	M	9/23/82	79118	Plan 2	Active	2/20/24	EE only
56	Subscriber	M	10/15/76	79015	Plan 1	Active	1/23/24	EE only
57	Subscriber	F	5/11/87	79109	Plan 2	Active	1/1/26	EE + Children
57	Dependent	M	1/28/04	79107	Plan 2	Active	1/1/26	EE + Children
57	Dependent	M	6/28/05	79109	Plan 2	Active	1/1/26	EE + Children
57	Dependent	F	8/18/06	79109	Plan 2	Active	1/1/26	EE + Children
57	Dependent	M	1/7/09	79109	Plan 2	Active	1/1/26	EE + Children
58	Subscriber	M	12/7/69	79108	Plan 1	Active	1/1/24	EE only
59	Subscriber	M	12/26/51	79103	Plan 2	Active	1/1/26	EE + Spouse
59	Spouse	F	6/21/51	79103	Plan 2	Active	1/1/26	EE + Spouse
60	Subscriber	M	12/13/74	79107	Plan 1	Active	4/14/25	EE + Children
60	Dependent	M	12/8/02	79107	Plan 1	Active	1/1/24	EE + Children
61	Subscriber	M	6/3/66	79118	Plan 1	Active	1/1/26	Family
61	Spouse	F	12/9/66	79118	Plan 1	Active	1/1/26	Family
61	Dependent	F	11/9/05	79118	Plan 1	Active	4/1/20	Family
62	Subscriber	M	1/17/78	79107	Plan 2	Active	1/1/25	EE + Children
62	Dependent	F	2/21/02	79107	Plan 2	Active	1/1/25	EE + Children
63	Subscriber	M	10/14/83	79109	Plan 1	Active	6/17/25	Family
63	Spouse	F	9/2/83	79109	Plan 1	Active	6/17/25	Family
63	Dependent	F	12/10/10	79109	Plan 1	Active	6/17/25	Family
63	Dependent	M	10/27/12	79109	Plan 1	Active	6/17/25	Family
64	Subscriber	M	4/8/77	79119	Plan 1	Active	1/1/26	Family
64	Spouse	F	1/2/81	79119	Plan 1	Active	1/1/26	Family
64	Dependent	F	9/10/01	79119	Plan 1	Active	1/1/26	Family
64	Dependent	M	1/27/04	79119	Plan 1	Active	1/1/26	Family
65	Subscriber	M	6/16/71	79106	Plan 1	Active	1/1/26	Family
65	Spouse	F	1/19/75	79106	Plan 1	Active	1/1/26	Family
65	Dependent	F	12/13/02	79106	Plan 1	Active	1/1/26	Family
65	Dependent	M	8/13/08	79106	Plan 1	Active	1/1/26	Family
66	Subscriber	M	12/2/71	79119	Plan 1	Active	1/5/26	EE only
67	Subscriber	M	8/5/80	79106	Plan 2	Active	6/9/26	Family
67	Spouse	F	12/23/83	79106	Plan 2	Active	6/9/26	Family
67	Dependent	F	1/29/11	79106	Plan 2	Active	6/11/25	Family
67	Dependent	M	11/21/12	79106	Plan 2	Active	6/11/25	Family
67	Dependent	M	10/5/18	79106	Plan 2	Active	6/11/25	Family
67	Dependent	F	1/7/20	79106	Plan 2	Active	6/11/25	Family
68	Subscriber	M	9/16/56	79109	Plan 2	Active	8/13/26	EE + Children
68	Dependent	M	9/24/01	79109	Plan 2	Active	1/1/26	EE + Children
68	Dependent	F	1/29/03	79109	Plan 2	Active	1/1/26	EE + Children
69	Subscriber	M	5/24/77	79086	Plan 1	Active	1/1/26	Family
69	Spouse	F	5/26/76	79086	Plan 1	Active	1/1/26	Family
69	Dependent	F	3/28/03	79086	Plan 1	Active	1/1/26	Family
69	Dependent	M	8/4/06	79086	Plan 1	Active	1/1/26	Family
70	Subscriber	F	6/24/75	79015	Plan 1	Active	8/6/26	EE + Spouse
70	Spouse	M	4/5/77	79015	Plan 1	Active	1/1/26	EE + Spouse
71	Subscriber	M	4/12/73	79102	Plan 2	Active	4/6/26	Family
71	Spouse	F	1/8/76	79102	Plan 2	Active	4/6/26	Family
71	Dependent	F	8/24/03	79102	Plan 2	Active	1/1/26	Family
71	Dependent	F	2/13/12	79102	Plan 2	Active	1/1/26	Family
72	Subscriber	F	7/17/83	79119	Plan 2	Active	7/12/25	EE only
73	Subscriber	F	4/25/76	79104	Plan 2	Active	1/19/26	EE only
74	Subscriber	M	2/23/84	79118	Plan 1	Active	1/1/26	Family
74	Spouse	F	11/3/80	79118	Plan 1	Active	1/1/26	Family
74	Dependent	F	7/18/03	79118	Plan 1	Active	1/1/26	Family
74	Dependent	F	9/9/03	79118	Plan 1	Active	1/1/26	Family
74	Dependent	M	12/8/04	79118	Plan 1	Active	1/1/26	Family
74	Dependent	F	11/25/05	79118	Plan 1	Active	1/1/26	Family
74	Dependent	M	11/25/05	79118	Plan 1	Active	1/1/26	Family
74	Dependent	F	2/29/08	79118	Plan 1	Active	1/1/26	Family
74	Dependent	M	12/12/12	79118	Plan 1	Active	1/1/26	Family
74	Dependent	M	5/31/14	79118	Plan 1	Active	1/1/26	Family
75	Subscriber	M	7/28/74	79119	Plan 1	Active	7/24/25	Family
75	Spouse	F	2/11/76	79119	Plan 1	Active	7/24/25	Family
75	Dependent	M	5/18/10	79119	Plan 1	Active	7/12/24	Family
76	Subscriber	M	6/30/64	79012	Plan 2	Active	1/1/26	EE + Spouse
76	Spouse	F	3/11/61	79012	Plan 2	Active	1/1/26	EE + Spouse
77	Subscriber	M	10/25/75	79106	Plan 2	Active	8/17/26	EE only
78	Subscriber	M	10/16/78	79118	Plan 1	Active	1/1/26	Family
78	Spouse	F	2/19/81	79118	Plan 1	Active	1/1/26	Family
78	Dependent	F	12/19/01	79118	Plan 1	Active	1/1/26	Family
78	Dependent	M	10/11/14	79118	Plan 1	Active	1/1/26	Family
79	Subscriber	M	2/10/84	79119	Plan 1	Active	1/15/26	Family
79	Spouse	F	10/26/85	79119	Plan 1	Active	1/1/26	Family
79	Dependent	M	3/10/15	79119	Plan 1	Active	1/1/26	Family
79	Dependent	F	10/11/18	79119	Plan 1	Active	1/1/26	Family
80	Subscriber	M	1/29/87	79124	Plan 1	Active	1/1/26	EE + Children
80	Dependent	M	9/23/15	79124	Plan 1	Active	1/1/26	EE + Children
80	Dependent	M	2/9/17	79124	Plan 1	Active	1/1/26	EE + Children
80	Dependent	F	11/15/18	79124	Plan 1	Active	1/1/26	EE + Children
81	Subscriber	M	11/10/84	79109	Plan 1	Active	1/1/26	Family
81	Spouse	F	11/11/86	79109	Plan 1	Active	1/1/26	Family
81	Dependent	M	6/15/16	79109	Plan 1	Active	1/1/26	Family
81	Dependent	F	3/25/18	79109	Plan 1	Active	1/1/26	Family
82	Subscriber	F	9/18/81	79107	Plan 1	Active	9/9/26	EE only
83	Subscriber	M	10/19/80	79106	Plan 2	Active	2/17/25	EE + Children
83	Dependent	M	9/24/09	79106	Plan 2	Active	2/17/25	EE + Children
83	Dependent	M	9/24/09	79106	Plan 2	Active	2/17/25	EE + Children
83	Dependent	M	4/23/19	79106	Plan 2	Active	2/17/25	EE + Children
84	Subscriber	M	6/17/80	79015	Plan 2	Active	7/20/26	Family
84	Spouse	F	11/5/76	79015	Plan 2	Active	7/20/26	Family
84	Dependent	F	4/17/06	79015	Plan 2	Active	1/1/26	Family
84	Dependent	M	8/22/08	79015	Plan 2	Active	1/1/26	Family
85	Subscriber	M	12/16/64	79119	Plan 2	Active	6/5/26	Family
85	Spouse	F	6/10/70	79012	Plan 2	Active	1/1/26	Family
85	Dependent	M	1/20/05	79012	Plan 2	Active	8/4/25	Family
86	Subscriber	M	6/19/81	79105	Plan 2	Active	6/6/26	Family
86	Spouse	F	10/10/81	79105	Plan 2	Active	1/1/26	Family
86	Dependent	M	9/14/08	79105	Plan 2	Active	1/1/26	Family
86	Dependent	M	10/11/13	79105	Plan 2	Active	1/1/26	Family
87	Subscriber	M	11/3/83	79119	Plan 1	Active	1/1/26	Family
87	Spouse	F	2/27/81	79119	Plan 1	Active	1/1/26	Family
87	Dependent	F	6/16/18	79119	Plan 1	Active	9/23/25	Family
87	Dependent	M	7/20/20	79119	Plan 1	Active	9/23/25	Family
88	Subscriber	M	10/15/87	79106	Plan 2	Active	1/1/26	Family
88	Spouse	F	12/10/87	79106	Plan 2	Active	1/1/26	Family
88	Dependent	F	2/4/10	79106	Plan 2	Active	1/1/23	Family
88	Dependent	F	12/7/22	79106	Plan 2	Active	1/1/26	Family
89	Subscriber	M	2/27/83	79106	Plan 2	Active	1/1/26	Family
89	Spouse	F	8/1/88	79106	Plan 2	Active	1/1/26	Family
89	Dependent	F	5/27/08	79106	Plan 2	Active	1/1/26	Family
89	Dependent	M	1/21/10	79106	Plan 2	Active	7/9/25	Family
89	Dependent	F	2/27/10	79106	Plan 2	Active	1/1/26	Family
89	Dependent	M	6/4/13	79106	Plan 2	Active	1/1/24	Family
89	Dependent	M	6/18/14	79106	Plan 2	Active	1/1/26	Family
90	Subscriber	F	10/15/85	79118	Plan 2	Active	9/13/26	Family
90	Spouse	M	2/12/85	79118	Plan 2	Active	1/1/26	Family
90	Dependent	M	1/27/05	79118	Plan 2	Active	9/13/26	Family
90	Dependent	M	3/13/08	79118	Plan 2	Active	1/1/26	Family
90	Dependent	F	3/7/17	79118	Plan 2	Active	1/1/26	Family
91	Subscriber	F	6/10/57	79106	Plan 1	Active	7/10/24	EE only
92	Subscriber	M	3/6/65	79107	Plan 2	Active	1/1/24	EE only
93	Subscriber	M	10/19/69	79118	Plan 1	Active	1/1/26	EE + Spouse
93	Spouse	F	4/3/75	79118	Plan 1	Active	1/1/26	EE + Spouse
94	Subscriber	M	6/22/69	79118	Plan 2	Active	8/11/26	EE + Spouse
94	Spouse	F	11/26/70	79118	Plan 2	Active	8/11/26	EE + Spouse
95	Subscriber	F	10/31/80	79106	Plan 2	Active	1/1/26	Family
95	Spouse	M	3/11/80	79106	Plan 2	Active	1/1/26	Family
95	Dependent	M	9/24/09	79106	Plan 2	Active	1/1/26	Family
95	Dependent	F	7/12/17	79106	Plan 2	Active	1/1/26	Family
96	Subscriber	M	3/24/80	79124	Plan 1	Active	1/1/26	Family
96	Spouse	F	6/13/82	79124	Plan 1	Active	1/1/26	Family
96	Dependent	M	5/25/10	79124	Plan 1	Active	1/1/26	Family
96	Dependent	M	7/7/17	79124	Plan 1	Active	1/1/26	Family
97	Subscriber	M	4/7/70	79108	Plan 1	Active	1/1/24	EE only
98	Subscriber	M	7/30/79	79119	Plan 2	Active	1/1/26	Family
98	Spouse	F	4/16/79	79119	Plan 2	Active	1/1/26	Family
98	Dependent	M	5/7/03	79119	Plan 2	Active	7/30/25	Family
98	Dependent	M	6/25/07	79119	Plan 2	Active	7/30/25	Family
98	Dependent	F	2/18/10	79119	Plan 2	Active	7/30/25	Family
99	Subscriber	M	2/17/83	79109	Plan 2	Active	1/1/26	EE + Children
99	Dependent	M	7/28/04	79109	Plan 2	Active	1/1/26	EE + Children
99	Dependent	M	10/3/06	79109	Plan 2	Active	1/1/26	EE + Children
99	Dependent	F	4/23/08	79109	Plan 2	Active	1/1/26	EE + Children
99	Dependent	F	4/23/08	79109	Plan 2	Active	1/1/26	EE + Children
100	Subscriber	F	8/3/71	79109	Plan 2	Active	1/1/26	EE + Spouse
100	Spouse	M	6/15/51	79109	Plan 2	Active	1/1/26	EE + Spouse
101	Subscriber	M	3/4/55	79109	Plan 1	Active	1/1/24	EE only
102	Subscriber	F	2/1/79	79088	Plan 2	Active	5/20/25	EE only
103	Subscriber	F	7/28/71	79124	Plan 2	Active	8/21/26	EE only
104	Subscriber	M	4/28/80	79118	Plan 2	Active	1/5/26	EE + Children
104	Dependent	F	4/21/09	79118	Plan 2	Active	1/5/26	EE + Children
104	Dependent	F	11/24/15	79118	Plan 2	Active	1/5/26	EE + Children
104	Dependent	F	11/28/17	79118	Plan 2	Active	1/5/26	EE + Children
105	Subscriber	M	5/29/83	79104	Plan 2	Active	1/1/26	Family
105	Spouse	F	5/4/78	79104	Plan 2	Active	1/1/26	Family
105	Dependent	F	12/4/02	79104	Plan 2	Active	1/1/26	Family
105	Dependent	F	1/6/04	79104	Plan 2	Active	1/1/26	Family
105	Dependent	F	3/31/05	79104	Plan 2	Active	1/1/26	Family
106	Subscriber	M	7/2/68	79107	Plan 2	Active	1/1/24	EE + Children
106	Dependent	M	10/3/16	79107	Plan 2	Active	1/1/24	EE + Children
107	Subscriber	M	11/7/84	79015	Plan 2	Active	7/29/26	EE + Children
107	Dependent	F	5/30/07	79109	Plan 2	Active	5/11/26	EE + Children
107	Dependent	F	5/31/09	79109	Plan 2	Active	5/11/26	EE + Children
107	Dependent	M	5/15/11	79109	Plan 2	Active	5/11/26	EE + Children
107	Dependent	F	6/19/26	79015	Plan 2	Active	6/19/26	EE + Children
108	Subscriber	F	2/16/82	79124	Plan 2	Retiree U65	6/8/26	Family
108	Spouse	M	12/3/77	79124	Plan 2	Retiree U65	2/24/26	Family
108	Dependent	M	9/22/08	79124	Plan 2	Retiree U65	6/8/26	Family
108	Dependent	M	12/4/08	79124	Plan 2	Retiree U65	2/24/26	Family
109	Subscriber	M	1/4/86	79124	Plan 1	Active	1/1/26	Family
109	Spouse	F	7/20/85	79124	Plan 1	Active	1/1/26	Family
109	Dependent	M	11/9/12	79124	Plan 1	Active	1/1/24	Family
109	Dependent	F	5/26/15	79124	Plan 1	Active	1/1/24	Family
109	Dependent	M	5/20/19	79124	Plan 1	Active	1/1/24	Family
110	Subscriber	M	11/29/80	79019	Plan 1	Retiree U65	8/31/26	EE only
111	Subscriber	M	4/4/78	79119	Plan 1	Active	1/5/26	EE only
112	Subscriber	M	2/5/82	79109	Plan 2	Active	9/1/26	Family
112	Spouse	F	6/13/80	79109	Plan 2	Active	9/1/26	Family
112	Dependent	M	6/25/10	79109	Plan 2	Active	9/1/26	Family
112	Dependent	M	4/19/12	79109	Plan 2	Active	9/1/26	Family
113	Subscriber	M	9/10/82	79045	Plan 2	Active	1/1/26	Family
113	Spouse	F	10/15/82	79045	Plan 2	Active	1/1/26	Family
113	Dependent	F	12/18/03	79045	Plan 2	Active	1/1/26	Family
113	Dependent	M	5/17/09	79045	Plan 2	Active	1/1/26	Family
114	Subscriber	M	1/20/88	79110	Plan 2	Active	1/19/26	EE only
115	Subscriber	M	3/30/88	79119	Plan 2	Active	1/1/26	EE + Children
115	Dependent	F	10/4/10	79119	Plan 2	Active	1/1/26	EE + Children
116	Subscriber	M	9/4/71	79118	Plan 1	Active	1/1/24	EE only
117	Subscriber	F	2/7/63	28139	Plan 1	Retiree U65	1/16/26	EE only
118	Subscriber	F	11/15/64	79109	Plan 2	Active	7/14/26	EE + Spouse
118	Spouse	M	9/18/63	79109	Plan 2	Active	6/10/26	EE + Spouse
119	Subscriber	M	7/17/74	79108	Plan 2	Active	3/31/26	EE + Children
119	Dependent	F	5/9/02	79108	Plan 2	Active	1/1/26	EE + Children
120	Subscriber	M	12/4/65	79107	Plan 1	Active	1/1/26	Family
120	Spouse	F	3/6/76	79107	Plan 1	Active	1/1/26	Family
120	Dependent	F	10/19/06	79107	Plan 1	Active	1/1/26	Family
120	Dependent	M	4/22/12	79107	Plan 1	Active	1/1/26	Family
121	Subscriber	M	9/27/77	79106	Plan 1	Active	8/29/26	Family
121	Spouse	F	9/18/92	79106	Plan 1	Active	1/1/26	Family
121	Dependent	M	3/11/02	79106	Plan 1	Active	1/1/26	Family
121	Dependent	M	12/22/09	79106	Plan 1	Active	1/1/26	Family
121	Dependent	M	12/31/14	79106	Plan 1	Active	1/1/26	Family
122	Subscriber	M	3/31/85	79110	Plan 1	Active	1/1/26	EE + Spouse
122	Spouse	F	10/27/88	79110	Plan 1	Active	1/1/26	EE + Spouse
123	Subscriber	M	9/5/84	79121	Plan 2	Active	1/1/26	Family
123	Spouse	F	4/25/88	79121	Plan 2	Active	1/1/26	Family
123	Dependent	F	10/19/10	79121	Plan 2	Active	1/1/26	Family
123	Dependent	M	4/17/14	79121	Plan 2	Active	1/1/26	Family
124	Subscriber	M	8/3/84	79110	Plan 1	Active	3/6/26	Family
124	Spouse	F	3/14/87	79110	Plan 1	Active	1/1/26	Family
124	Dependent	M	4/19/15	79110	Plan 1	Active	1/1/26	Family
124	Dependent	F	10/14/16	79110	Plan 1	Active	1/1/26	Family
125	Subscriber	M	1/8/81	79108	Plan 2	Active	6/1/26	EE only
126	Subscriber	F	7/7/75	79120	Plan 1	Active	1/1/26	EE + Spouse
126	Spouse	M	6/10/68	79120	Plan 1	Active	1/1/26	EE + Spouse
127	Subscriber	M	8/6/72	79109	Plan 2	Active	1/29/25	EE + Children
127	Dependent	M	2/9/01	79109	Plan 2	Active	5/28/22	EE + Children
128	Subscriber	M	2/19/82	79109	Plan 1	Active	1/1/26	Family
128	Spouse	F	3/6/83	79109	Plan 1	Active	1/1/26	Family
128	Dependent	F	11/11/09	79109	Plan 1	Active	1/1/26	Family
128	Dependent	M	12/1/16	79109	Plan 1	Active	1/1/26	Family
129	Subscriber	M	6/19/82	79119	Plan 2	Active	6/12/26	Family
129	Spouse	F	10/30/84	79119	Plan 2	Active	1/1/26	Family
129	Dependent	M	1/21/10	79119	Plan 2	Active	1/1/26	Family
129	Dependent	M	8/3/13	79119	Plan 2	Active	1/1/26	Family
130	Subscriber	M	1/29/86	79118	Plan 2	Active	9/23/24	EE + Children
130	Dependent	M	5/17/16	79118	Plan 2	Active	1/1/24	EE + Children
130	Dependent	M	12/17/18	79118	Plan 2	Active	1/1/24	EE + Children
131	Subscriber	M	4/17/75	79109	Plan 1	Active	1/1/26	EE + Children
131	Dependent	M	10/17/00	79109	Plan 1	Active	4/1/20	EE + Children
131	Dependent	M	12/13/03	79109	Plan 1	Active	4/1/20	EE + Children
131	Dependent	F	12/1/06	79109	Plan 1	Active	1/1/26	EE + Children
132	Subscriber	M	8/9/76	79124	Plan 2	Active	3/2/26	EE only
133	Subscriber	M	8/14/83	79092	Plan 1	Active	9/1/26	Family
133	Spouse	F	11/10/83	79092	Plan 1	Active	5/13/24	Family
133	Dependent	F	3/23/11	79092	Plan 1	Active	5/13/24	Family
133	Dependent	F	6/3/13	79092	Plan 1	Active	5/13/24	Family
133	Dependent	M	6/3/13	79092	Plan 1	Active	5/13/24	Family
134	Subscriber	M	2/1/71	79124	Plan 2	Active	3/26/25	EE only
135	Subscriber	M	9/30/58	79015	Plan 1	Active	5/1/26	Family
135	Spouse	F	7/15/62	79015	Plan 1	Active	1/1/26	Family
135	Dependent	M	9/25/14	79015	Plan 1	Active	1/1/26	Family
136	Subscriber	M	12/2/81	79015	Plan 2	Active	6/22/26	Family
136	Spouse	F	3/31/83	79015	Plan 2	Active	6/22/26	Family
136	Dependent	F	1/1/05	79015	Plan 2	Active	1/1/25	Family
136	Dependent	M	8/29/11	79015	Plan 2	Active	11/11/24	Family
137	Subscriber	M	4/23/85	79118	Plan 1	Active	1/1/26	EE + Children
137	Dependent	F	12/17/17	79118	Plan 1	Active	1/1/26	EE + Children
138	Subscriber	F	12/30/65	79109	Plan 1	Active	7/21/25	EE only
139	Subscriber	F	5/20/64	79110	Plan 1	Retiree U65	6/26/26	EE + Spouse
139	Spouse	M	9/7/65	79110	Plan 1	Retiree U65	1/1/24	EE + Spouse
140	Subscriber	F	9/26/65	79106	Plan 2	Active	6/3/26	EE only
141	Subscriber	M	8/12/79	79109	Plan 2	Active	1/1/26	Family
141	Spouse	F	9/9/82	79109	Plan 2	Active	1/1/26	Family
141	Dependent	M	5/27/09	79109	Plan 2	Active	1/1/26	Family
141	Dependent	M	12/5/13	79109	Plan 2	Active	1/1/26	Family
142	Subscriber	M	11/28/78	79109	Plan 1	Active	1/1/26	EE + Children
142	Dependent	F	11/10/07	79109	Plan 1	Active	1/1/26	EE + Children
142	Dependent	M	4/27/11	79109	Plan 1	Active	1/1/26	EE + Children
143	Subscriber	M	8/14/83	79119	Plan 1	Active	10/17/24	Family
143	Spouse	F	11/12/87	79119	Plan 1	Active	1/29/23	Family
143	Dependent	M	5/30/18	79119	Plan 1	Active	1/29/23	Family
143	Dependent	F	11/20/19	79119	Plan 1	Active	1/29/23	Family
144	Subscriber	M	12/17/72	79106	Plan 2	Active	3/1/25	EE only
145	Subscriber	M	1/4/75	79109	Plan 2	Active	4/15/26	Family
145	Spouse	F	12/27/77	79109	Plan 2	Active	1/1/26	Family
145	Dependent	M	10/1/09	79109	Plan 2	Active	1/1/26	Family
145	Dependent	F	8/8/11	79109	Plan 2	Active	1/1/26	Family
146	Subscriber	M	9/28/85	79118	Plan 1	Active	1/1/26	EE + Children
146	Dependent	M	7/23/15	79118	Plan 1	Active	1/1/26	EE + Children
146	Dependent	M	7/24/18	79118	Plan 1	Active	1/1/26	EE + Children
147	Subscriber	M	1/17/87	79015	Plan 2	Active	2/3/25	Family
147	Spouse	F	9/17/87	79015	Plan 2	Active	2/3/25	Family
147	Dependent	F	8/22/13	79015	Plan 2	Active	2/3/25	Family
147	Dependent	F	3/28/16	79015	Plan 2	Active	2/3/25	Family
147	Dependent	M	1/3/20	79015	Plan 2	Active	2/3/25	Family
147	Dependent	F	11/30/23	79015	Plan 2	Active	2/3/25	Family
148	Subscriber	M	7/20/84	79119	Plan 1	Active	1/2/25	EE only
149	Subscriber	M	10/17/86	79109	Plan 1	Active	7/27/26	Family
149	Spouse	F	10/2/86	79109	Plan 1	Active	3/9/26	Family
149	Dependent	F	9/30/13	79109	Plan 1	Active	3/9/26	Family
149	Dependent	M	5/28/15	79109	Plan 1	Active	3/9/26	Family
150	Subscriber	M	3/11/85	79104	Plan 2	Active	1/1/26	Family
150	Spouse	F	4/19/86	79104	Plan 2	Active	1/1/26	Family
150	Dependent	F	7/8/09	79104	Plan 2	Active	1/1/26	Family
150	Dependent	M	4/17/14	79104	Plan 2	Active	1/1/26	Family
151	Subscriber	M	5/9/86	79124	Plan 1	Active	3/23/26	Family
151	Spouse	F	6/12/90	79124	Plan 1	Active	3/23/26	Family
151	Dependent	M	5/16/18	79124	Plan 1	Active	5/16/23	Family
151	Dependent	M	11/27/20	79124	Plan 1	Active	5/16/23	Family
152	Subscriber	M	1/3/64	79102	Plan 1	Active	1/7/25	EE only
153	Subscriber	F	9/18/79	79109	Plan 1	Active	6/4/26	EE only
154	Subscriber	M	1/11/78	79120	Plan 1	Active	1/19/26	EE + Children
154	Dependent	F	7/23/05	79015	Plan 1	Active	1/19/26	EE + Children
154	Dependent	F	1/8/09	79015	Plan 1	Active	1/19/26	EE + Children
154	Dependent	M	1/17/18	79015	Plan 1	Active	1/19/26	EE + Children
155	Subscriber	M	9/10/80	79110	Plan 2	Active	1/1/24	Family
155	Spouse	F	5/5/84	79110	Plan 2	Active	1/1/24	Family
155	Dependent	M	8/30/01	79110	Plan 2	Active	1/1/24	Family
155	Dependent	F	12/7/05	79110	Plan 2	Active	1/1/24	Family
155	Dependent	M	11/7/08	79110	Plan 2	Active	1/1/24	Family
156	Subscriber	M	2/3/69	79106	Plan 1	Active	6/8/26	EE only
157	Subscriber	M	4/9/86	79015	Plan 2	Active	6/15/26	Family
157	Spouse	F	3/5/85	79015	Plan 2	Active	6/1/26	Family
157	Dependent	F	5/25/13	79015	Plan 2	Active	6/1/26	Family
157	Dependent	M	3/15/16	79015	Plan 2	Active	6/1/26	Family
158	Subscriber	M	5/1/81	79119	Plan 1	Active	1/1/26	EE + Spouse
158	Spouse	F	3/5/85	79119	Plan 1	Active	1/1/26	EE + Spouse
159	Subscriber	M	5/1/72	79118	Plan 2	Active	1/1/26	EE + Spouse
159	Spouse	F	11/21/74	79118	Plan 2	Active	1/1/26	EE + Spouse
160	Subscriber	M	4/30/74	79118	Plan 2	Active	1/1/24	EE only
161	Subscriber	M	1/6/82	79015	Plan 2	Active	1/15/26	Family
161	Spouse	F	6/19/81	79015	Plan 2	Active	1/15/26	Family
161	Dependent	M	8/16/01	79015	Plan 2	Active	1/14/26	Family
161	Dependent	F	6/1/05	79015	Plan 2	Active	1/1/26	Family
162	Subscriber	M	4/15/74	79107	Plan 1	Active	8/31/26	Family
162	Spouse	F	8/13/79	79107	Plan 1	Active	1/1/26	Family
162	Dependent	F	8/3/09	79107	Plan 1	Active	1/1/26	Family
163	Subscriber	F	1/16/79	79103	Plan 1	Active	1/1/26	EE + Spouse
163	Spouse	F	2/8/81	79103	Plan 1	Active	1/1/26	EE + Spouse
164	Subscriber	F	10/16/57	79119	Plan 1	Active	1/1/26	EE + Spouse
164	Spouse	M	3/10/61	79119	Plan 1	Active	1/1/26	EE + Spouse
165	Subscriber	F	8/2/68	79015	Plan 2	Active	7/8/26	Family
165	Spouse	M	3/20/69	79015	Plan 2	Active	1/1/26	Family
165	Dependent	F	6/15/05	79015	Plan 2	Active	1/1/26	Family
166	Subscriber	F	6/10/66	79110	Plan 2	Active	1/11/26	EE only
167	Subscriber	M	7/25/63	79106	Plan 1	Active	8/17/26	EE only
168	Subscriber	M	6/25/77	79109	Plan 2	Active	8/10/26	Family
168	Spouse	F	12/2/77	79109	Plan 2	Active	8/10/26	Family
168	Dependent	F	11/23/11	79109	Plan 2	Active	8/10/26	Family
169	Subscriber	M	2/21/81	79107	Plan 2	Active	1/1/24	EE + Children
169	Dependent	F	10/21/00	79107	Plan 2	Active	1/1/24	EE + Children
170	Subscriber	M	10/14/81	79124	Plan 1	Active	1/1/26	Family
170	Spouse	F	7/31/83	79124	Plan 1	Active	1/1/26	Family
170	Dependent	M	2/24/04	79124	Plan 1	Active	1/1/26	Family
170	Dependent	F	11/20/06	79124	Plan 1	Active	1/1/26	Family
170	Dependent	F	1/3/14	79124	Plan 1	Active	1/1/26	Family
171	Subscriber	M	9/24/80	79119	Plan 1	Active	1/1/26	Family
171	Spouse	F	12/17/80	79119	Plan 1	Active	1/1/26	Family
171	Dependent	F	9/20/01	79119	Plan 1	Active	1/1/26	Family
171	Dependent	F	2/15/03	79119	Plan 1	Active	1/1/26	Family
171	Dependent	F	3/11/07	79119	Plan 1	Active	1/1/26	Family
171	Dependent	F	7/31/10	79119	Plan 1	Active	1/1/26	Family
172	Subscriber	M	10/27/87	79118	Plan 2	Active	1/1/26	Family
172	Spouse	F	5/12/89	79118	Plan 2	Active	1/1/26	Family
172	Dependent	M	6/13/15	79118	Plan 2	Active	1/1/26	Family
172	Dependent	M	12/10/18	79118	Plan 2	Active	1/1/26	Family
173	Subscriber	M	3/1/87	79036	Plan 2	Active	5/19/25	EE only
174	Subscriber	M	3/13/74	79118	Plan 2	Active	8/10/26	EE + Children
174	Dependent	F	5/28/15	79118	Plan 2	Active	1/1/26	EE + Children
175	Subscriber	F	11/12/63	79106	Plan 1	Active	1/1/24	EE only
176	Subscriber	F	7/2/72	79106	Plan 2	Active	7/16/25	EE only
177	Subscriber	M	11/10/61	79109	Plan 2	Retiree U65	6/6/26	EE + Spouse
177	Spouse	F	9/17/63	79109	Plan 2	Retiree U65	6/6/26	EE + Spouse
178	Subscriber	F	2/25/69	79121	Plan 1	Active	8/30/25	EE only
179	Subscriber	M	3/30/83	79124	Plan 1	Retiree U65	1/1/25	EE only
180	Subscriber	M	9/24/76	79107	Plan 2	Active	1/1/22	EE only
181	Subscriber	M	5/19/67	79103	Plan 2	Active	6/1/26	EE only
182	Subscriber	M	7/7/84	79119	Plan 2	Active	6/5/26	Family
182	Spouse	F	8/18/84	79119	Plan 2	Active	12/11/24	Family
182	Dependent	M	3/23/23	79119	Plan 2	Active	11/16/23	Family
182	Dependent	M	11/20/24	79119	Plan 2	Active	1/1/25	Family
183	Subscriber	M	5/13/80	79109	Plan 2	Active	1/1/26	Family
183	Spouse	F	11/1/83	79109	Plan 2	Active	1/1/26	Family
183	Dependent	M	10/7/07	79109	Plan 2	Active	1/1/26	Family
183	Dependent	F	4/22/13	79109	Plan 2	Active	1/1/26	Family
184	Subscriber	M	8/5/85	79118	Plan 1	Active	1/1/26	Family
184	Spouse	F	6/5/85	79118	Plan 1	Active	1/1/26	Family
184	Dependent	M	12/29/06	79118	Plan 1	Active	1/1/24	Family
184	Dependent	F	12/17/11	79118	Plan 1	Active	1/1/24	Family
185	Subscriber	M	5/12/81	79109	Plan 2	Active	1/1/24	EE only
186	Subscriber	M	10/24/86	79119	Plan 2	Active	1/5/26	Family
186	Spouse	F	8/1/86	79119	Plan 2	Active	1/5/26	Family
186	Dependent	F	4/27/14	79119	Plan 2	Active	1/5/26	Family
187	Subscriber	M	6/28/85	79068	Plan 2	Active	6/24/26	EE + Children
187	Dependent	M	11/20/08	79068	Plan 2	Active	1/1/26	EE + Children
187	Dependent	F	6/3/10	79068	Plan 2	Active	3/16/26	EE + Children
188	Subscriber	F	1/6/76	79108	Plan 2	Active	8/25/26	EE + Children
188	Dependent	M	12/3/08	79108	Plan 2	Active	1/1/26	EE + Children
189	Subscriber	M	5/3/78	79109	Plan 1	Active	1/4/25	EE only
190	Subscriber	M	12/2/75	79114	Plan 2	Active	1/1/26	Family
190	Spouse	F	6/15/77	79114	Plan 2	Active	1/1/26	Family
190	Dependent	F	4/24/07	79114	Plan 2	Active	1/1/26	Family
191	Subscriber	F	3/15/66	79019	Plan 2	Active	1/1/26	EE + Spouse
191	Spouse	M	7/15/65	79019	Plan 2	Active	1/1/26	EE + Spouse
192	Subscriber	M	3/6/70	79110	Plan 1	Active	1/1/24	EE only
193	Subscriber	M	2/5/77	79119	Plan 1	Active	1/1/26	Family
193	Spouse	F	2/28/79	79119	Plan 1	Active	1/1/26	Family
193	Dependent	F	3/26/04	79119	Plan 1	Active	1/1/26	Family
193	Dependent	M	1/9/11	79119	Plan 1	Active	1/1/26	Family
193	Dependent	F	8/24/12	79119	Plan 1	Active	1/1/26	Family
193	Dependent	F	9/10/15	79119	Plan 1	Active	1/1/26	Family
194	Subscriber	M	12/12/79	79109	Plan 2	Active	1/5/26	Family
194	Spouse	F	11/3/80	79109	Plan 2	Active	1/5/26	Family
194	Dependent	M	5/20/11	79109	Plan 2	Active	1/5/26	Family
194	Dependent	M	8/7/13	79109	Plan 2	Active	1/5/26	Family
194	Dependent	F	10/19/17	79109	Plan 2	Active	1/5/26	Family
195	Subscriber	M	4/22/84	79118	Plan 2	Active	1/1/26	Family
195	Spouse	F	5/1/87	79118	Plan 2	Active	1/1/26	Family
195	Dependent	M	10/13/15	79118	Plan 2	Active	1/1/26	Family
195	Dependent	F	4/29/17	79118	Plan 2	Active	1/1/26	Family
195	Dependent	F	3/18/20	79118	Plan 2	Active	1/1/26	Family
196	Subscriber	M	3/26/88	79124	Plan 2	Active	6/7/26	Family
196	Spouse	F	9/10/84	79124	Plan 2	Active	1/1/26	Family
196	Dependent	F	3/18/10	79124	Plan 2	Active	1/1/26	Family
196	Dependent	M	7/10/12	79124	Plan 2	Active	1/1/26	Family
196	Dependent	M	9/1/14	79124	Plan 2	Active	1/1/26	Family
196	Dependent	F	2/24/17	79124	Plan 2	Active	1/1/26	Family
197	Subscriber	M	6/17/88	79124	Plan 1	Active	1/1/26	Family
197	Spouse	F	4/18/89	79124	Plan 1	Active	1/1/26	Family
197	Dependent	F	3/25/08	79124	Plan 1	Active	1/1/26	Family
197	Dependent	M	2/4/09	79124	Plan 1	Active	1/1/26	Family
197	Dependent	F	11/24/15	79124	Plan 1	Active	1/1/26	Family
197	Dependent	F	1/9/21	79124	Plan 1	Active	1/1/26	Family
198	Subscriber	M	6/17/88	79109	Plan 1	Active	1/5/26	EE only
199	Subscriber	M	10/13/62	79124	Plan 1	Active	9/7/26	EE + Spouse
199	Spouse	F	4/17/64	79124	Plan 1	Active	2/24/26	EE + Spouse
200	Subscriber	M	10/21/61	79118	Plan 1	Retiree U65	7/17/26	EE only
201	Subscriber	M	9/19/78	79124	Plan 2	Active	6/16/26	Family
201	Spouse	F	7/29/81	79124	Plan 2	Active	1/1/26	Family
201	Dependent	F	12/15/05	79124	Plan 2	Active	1/1/26	Family
201	Dependent	F	11/11/08	79124	Plan 2	Active	1/1/26	Family
201	Dependent	M	3/15/16	79124	Plan 2	Active	1/1/26	Family
201	Dependent	M	3/15/18	79124	Plan 2	Active	1/1/26	Family
202	Subscriber	M	12/31/77	79068	Plan 1	Active	2/5/26	Family
202	Spouse	F	12/6/82	79068	Plan 1	Active	1/1/26	Family
202	Dependent	F	4/19/05	79068	Plan 1	Active	1/1/26	Family
202	Dependent	F	12/21/19	79068	Plan 1	Active	1/1/26	Family
202	Dependent	F	12/5/22	79068	Plan 1	Active	1/1/26	Family
203	Subscriber	F	6/12/80	79110	Plan 1	Active	1/1/26	Family
203	Spouse	M	12/15/77	79110	Plan 1	Active	1/1/26	Family
203	Dependent	F	4/2/11	79110	Plan 1	Active	4/1/20	Family
203	Dependent	F	12/12/12	79110	Plan 1	Active	4/1/20	Family
203	Dependent	M	9/23/15	79110	Plan 1	Active	4/1/20	Family
204	Subscriber	M	9/5/79	79109	Plan 1	Active	1/1/26	Family
204	Spouse	F	11/10/75	79109	Plan 1	Active	1/1/26	Family
204	Dependent	M	3/3/04	79109	Plan 1	Active	1/1/26	Family
204	Dependent	F	4/7/08	79109	Plan 1	Active	1/1/26	Family
204	Dependent	M	9/26/13	79109	Plan 1	Active	1/1/26	Family
205	Subscriber	M	1/4/77	79015	Plan 1	Active	1/1/26	EE + Children
205	Dependent	M	8/15/06	79015	Plan 1	Active	1/1/26	EE + Children
205	Dependent	M	10/19/13	79015	Plan 1	Active	1/1/26	EE + Children
206	Subscriber	M	1/27/84	79109	Plan 1	Active	1/1/26	EE + Children
206	Dependent	F	11/26/11	79109	Plan 1	Active	1/1/26	EE + Children
206	Dependent	F	8/13/19	79109	Plan 1	Active	1/1/26	EE + Children
207	Subscriber	F	1/13/76	79015	Plan 2	Active	6/3/25	EE only
208	Subscriber	F	2/29/80	79106	Plan 2	Active	9/30/24	EE only
209	Subscriber	M	4/9/81	79109	Plan 2	Active	7/29/24	EE only
210	Subscriber	F	3/22/62	79015	Plan 2	Active	1/1/26	EE + Children
210	Dependent	M	8/15/97	79015	Plan 2	Active	1/1/26	EE + Children
211	Subscriber	M	12/21/64	79109	Plan 2	Active	1/18/24	EE only
212	Subscriber	M	12/25/70	79124	Plan 1	Active	9/17/25	EE only
213	Subscriber	M	4/19/72	79106	Plan 2	Active	1/1/26	Family
213	Spouse	F	9/30/79	79106	Plan 2	Active	1/1/26	Family
213	Dependent	M	12/5/02	79106	Plan 2	Active	1/1/26	Family
213	Dependent	F	6/6/05	79106	Plan 2	Active	1/1/26	Family
214	Subscriber	F	10/31/82	79109	Plan 1	Active	7/17/25	EE only
215	Subscriber	M	3/17/72	79103	Plan 1	Active	1/1/26	EE + Spouse
215	Spouse	F	3/23/72	79103	Plan 1	Active	1/1/26	EE + Spouse
216	Subscriber	M	2/5/86	79015	Plan 2	Active	1/5/26	EE only
217	Subscriber	M	3/13/83	79015	Plan 2	Active	1/1/24	EE + Children
217	Dependent	F	1/13/16	79015	Plan 2	Active	4/20/22	EE + Children
218	Subscriber	M	6/4/84	79110	Plan 2	Active	9/28/24	EE only
219	Subscriber	F	8/5/76	79102	Plan 1	Active	1/1/24	EE only
220	Subscriber	M	6/23/87	79015	Plan 2	Active	2/11/26	Family
220	Spouse	F	7/28/88	79015	Plan 2	Active	1/1/26	Family
220	Dependent	F	8/3/09	79015	Plan 2	Active	1/1/26	Family
220	Dependent	M	5/14/13	79015	Plan 2	Active	1/1/26	Family
221	Subscriber	M	5/9/76	79109	Plan 1	Active	1/1/24	EE only
222	Subscriber	F	10/6/83	79109	Plan 1	Active	1/1/24	EE only
223	Subscriber	M	3/1/72	79015	Plan 2	Active	6/25/26	Family
223	Spouse	F	2/22/72	79015	Plan 2	Active	6/25/26	Family
223	Dependent	F	2/26/02	79015	Plan 2	Active	1/1/26	Family
223	Dependent	F	2/26/02	79015	Plan 2	Active	1/1/26	Family
223	Dependent	F	2/13/04	79015	Plan 2	Active	1/1/26	Family
224	Subscriber	M	4/6/62	79109	Plan 2	Active	8/7/24	EE only
225	Subscriber	M	7/5/74	79109	Plan 1	Active	1/1/26	Family
225	Spouse	F	3/6/81	79109	Plan 1	Active	1/1/26	Family
225	Dependent	F	6/7/08	79109	Plan 1	Active	1/1/26	Family
225	Dependent	M	2/22/10	79109	Plan 1	Active	1/1/26	Family
226	Subscriber	M	7/28/76	79124	Plan 1	Active	1/1/26	Family
226	Spouse	F	8/8/80	79124	Plan 1	Active	1/1/26	Family
226	Dependent	F	9/27/05	79124	Plan 1	Active	1/1/26	Family
226	Dependent	F	10/22/10	79124	Plan 1	Active	1/1/26	Family
226	Dependent	M	5/22/12	79124	Plan 1	Active	1/1/26	Family
227	Subscriber	M	6/28/82	79106	Plan 1	Active	1/1/26	Family
227	Spouse	F	4/30/83	79106	Plan 1	Active	1/1/26	Family
227	Dependent	M	5/7/12	79106	Plan 1	Active	1/1/26	Family
227	Dependent	F	6/25/14	79106	Plan 1	Active	1/1/26	Family
227	Dependent	F	6/30/17	79106	Plan 1	Active	1/1/26	Family
228	Subscriber	M	12/16/69	79105	Plan 2	Active	1/1/24	EE + Spouse
228	Spouse	F	12/16/74	79105	Plan 2	Active	1/1/24	EE + Spouse
229	Subscriber	M	11/13/84	79106	Plan 2	Active	11/3/25	EE only
230	Subscriber	M	12/16/84	79118	Plan 1	Active	7/21/25	EE + Spouse
230	Spouse	F	7/4/82	79118	Plan 1	Active	7/21/25	EE + Spouse
231	Subscriber	M	6/21/80	79119	Plan 2	Active	1/1/26	Family
231	Spouse	F	1/16/81	79119	Plan 2	Active	1/1/26	Family
231	Dependent	F	2/28/08	79119	Plan 2	Active	1/1/26	Family
231	Dependent	M	3/21/12	79119	Plan 2	Active	1/1/26	Family
231	Dependent	M	3/19/14	79119	Plan 2	Active	1/1/26	Family
231	Dependent	F	1/19/17	79119	Plan 2	Active	1/1/26	Family
231	Dependent	F	4/30/19	79119	Plan 2	Active	1/1/26	Family
232	Subscriber	M	8/16/78	79104	Plan 1	Active	2/3/26	EE + Children
232	Dependent	F	10/11/02	79104	Plan 1	Active	1/14/26	EE + Children
232	Dependent	F	8/6/06	79104	Plan 1	Active	1/1/24	EE + Children
233	Subscriber	M	4/22/87	79015	Plan 1	Active	1/1/26	Family
233	Spouse	F	12/22/86	79015	Plan 1	Active	1/1/26	Family
233	Dependent	F	7/10/14	79015	Plan 1	Active	1/1/26	Family
233	Dependent	M	3/1/18	79015	Plan 1	Active	1/1/26	Family
234	Subscriber	M	2/27/76	79118	Plan 1	Active	7/1/25	Family
234	Spouse	F	5/13/70	79118	Plan 1	Active	1/1/24	Family
234	Dependent	M	12/1/01	79118	Plan 1	Active	1/1/24	Family
234	Dependent	F	12/7/04	79118	Plan 1	Active	1/1/24	Family
234	Dependent	F	12/19/05	79118	Plan 1	Active	1/1/24	Family
235	Subscriber	M	10/20/72	79109	Plan 2	Active	4/7/26	EE only
236	Subscriber	M	2/14/81	79119	Plan 1	Active	1/1/24	EE + Children
236	Dependent	F	3/24/06	79119	Plan 1	Active	3/17/22	EE + Children
236	Dependent	F	10/5/07	79119	Plan 1	Active	3/17/22	EE + Children
236	Dependent	M	2/22/10	79119	Plan 1	Active	3/17/22	EE + Children
236	Dependent	F	8/7/12	79119	Plan 1	Active	3/17/22	EE + Children
237	Subscriber	M	9/1/87	79118	Plan 2	Active	1/1/26	Family
237	Spouse	F	4/10/90	79118	Plan 2	Active	1/1/26	Family
237	Dependent	F	12/2/09	79118	Plan 2	Active	1/1/26	Family
237	Dependent	F	4/24/17	79118	Plan 2	Active	1/1/26	Family
238	Subscriber	M	4/12/65	79118	Plan 1	Active	1/1/26	EE + Spouse
238	Spouse	F	12/2/57	79118	Plan 1	Active	1/1/26	EE + Spouse
239	Subscriber	M	11/15/72	79107	Plan 1	Active	1/1/24	EE only
240	Subscriber	M	11/16/64	79110	Plan 2	Active	1/1/26	Family
240	Spouse	F	4/20/65	79110	Plan 2	Active	1/1/26	Family
240	Dependent	M	10/25/04	79110	Plan 2	Active	1/1/26	Family
240	Dependent	F	6/22/11	79110	Plan 2	Active	1/1/26	Family
241	Subscriber	M	4/28/63	79106	Plan 2	Active	1/1/26	EE + Spouse
241	Spouse	F	2/21/62	79106	Plan 2	Active	1/1/26	EE + Spouse
242	Subscriber	F	9/17/67	79015	Plan 2	Active	3/23/25	EE only
243	Subscriber	M	7/19/82	79119	Plan 2	Active	1/1/26	EE + Children
243	Dependent	F	5/4/01	79119	Plan 2	Active	1/1/26	EE + Children
243	Dependent	M	5/27/04	79119	Plan 2	Active	1/1/26	EE + Children
243	Dependent	F	11/18/10	79119	Plan 2	Active	1/1/26	EE + Children
244	Subscriber	M	3/20/85	79110	Plan 2	Active	3/27/25	EE only
245	Subscriber	F	6/15/82	79107	Plan 1	Active	2/21/26	EE + Children
245	Dependent	M	3/25/06	79107	Plan 1	Active	1/1/26	EE + Children
245	Dependent	F	7/23/08	79107	Plan 1	Active	1/1/26	EE + Children
246	Subscriber	M	8/1/75	79019	Plan 1	Active	7/9/26	Family
246	Spouse	F	2/1/71	79019	Plan 1	Active	1/1/26	Family
246	Dependent	F	2/3/05	79019	Plan 1	Active	1/1/26	Family
247	Subscriber	M	4/13/79	79119	Plan 1	Active	1/19/26	Family
247	Spouse	F	3/20/82	79119	Plan 1	Active	1/19/26	Family
247	Dependent	F	3/22/03	79119	Plan 1	Active	1/19/26	Family
247	Dependent	F	11/4/05	79119	Plan 1	Active	1/19/26	Family
248	Subscriber	M	2/25/67	79103	Plan 1	Active	1/1/26	Family
248	Spouse	F	9/25/67	79103	Plan 1	Active	1/1/26	Family
248	Dependent	M	9/27/06	79103	Plan 1	Active	1/1/26	Family
249	Subscriber	M	3/15/73	79110	Plan 1	Active	8/22/25	EE only
250	Subscriber	M	8/1/81	79119	Plan 1	Active	3/10/25	EE only
251	Subscriber	M	8/22/69	79088	Plan 2	Active	9/2/26	EE + Spouse
251	Spouse	F	8/5/76	79088	Plan 2	Active	1/1/26	EE + Spouse
252	Subscriber	M	3/23/71	79121	Plan 2	Active	1/12/26	EE + Children
252	Dependent	F	2/20/04	79121	Plan 2	Active	1/12/26	EE + Children
253	Subscriber	M	1/31/82	79109	Plan 2	Active	6/30/26	EE + Children
253	Dependent	M	2/1/04	79109	Plan 2	Active	1/1/26	EE + Children
254	Subscriber	M	4/22/83	79226	Plan 2	Active	1/1/24	EE only
255	Subscriber	M	12/29/84	79109	Plan 1	Active	1/16/25	EE only
256	Subscriber	M	2/20/83	79119	Plan 2	Active	1/1/26	Family
256	Spouse	F	8/19/84	79119	Plan 2	Active	1/1/26	Family
256	Dependent	M	11/12/08	79119	Plan 2	Active	1/1/26	Family
256	Dependent	F	8/11/10	79119	Plan 2	Active	1/1/26	Family
257	Subscriber	M	7/13/85	79015	Plan 2	Active	6/22/26	Family
257	Spouse	F	7/23/96	79015	Plan 2	Active	3/30/26	Family
257	Dependent	F	8/20/14	79015	Plan 2	Active	2/16/26	Family
257	Dependent	F	9/8/17	79015	Plan 2	Active	2/16/26	Family
258	Subscriber	M	2/20/64	77650	Plan 1	Retiree U65	3/31/26	EE + Spouse
258	Spouse	F	2/21/70	77650	Plan 1	Retiree U65	1/1/24	EE + Spouse
259	Subscriber	M	10/24/79	79119	Plan 2	Active	7/29/25	EE only
260	Subscriber	M	6/3/78	79119	Plan 1	Active	6/15/26	EE + Children
260	Dependent	M	5/31/16	79119	Plan 1	Active	6/15/26	EE + Children
261	Subscriber	M	6/19/84	79015	Plan 2	Active	8/17/26	Family
261	Spouse	F	12/18/86	79015	Plan 2	Active	8/17/26	Family
261	Dependent	M	1/15/13	79015	Plan 2	Active	8/17/26	Family
261	Dependent	M	5/23/14	79015	Plan 2	Active	8/17/26	Family
261	Dependent	F	5/12/17	79015	Plan 2	Active	8/17/26	Family
262	Subscriber	M	8/7/85	79015	Plan 2	Active	7/27/26	EE only
263	Subscriber	M	5/5/69	79107	Plan 1	Active	1/1/26	EE + Spouse
263	Spouse	F	2/5/70	79107	Plan 1	Active	1/1/26	EE + Spouse
264	Subscriber	M	6/2/81	79119	Plan 1	Active	1/1/24	Family
264	Spouse	F	9/27/83	79119	Plan 1	Active	4/1/20	Family
264	Dependent	M	11/30/12	79119	Plan 1	Active	4/1/20	Family
264	Dependent	M	12/7/16	79119	Plan 1	Active	4/1/20	Family
265	Subscriber	F	2/20/61	79118	Plan 2	Active	1/1/24	EE only
266	Subscriber	M	5/12/81	79118	Plan 2	Active	1/1/26	Family
266	Spouse	F	7/1/93	79118	Plan 2	Active	1/1/26	Family
266	Dependent	F	11/20/01	79118	Plan 2	Active	1/1/26	Family
266	Dependent	M	2/22/06	79118	Plan 2	Active	1/1/26	Family
266	Dependent	M	8/22/17	79118	Plan 2	Active	1/1/26	Family
266	Dependent	F	4/24/19	79118	Plan 2	Active	1/1/26	Family
266	Dependent	F	6/13/22	79118	Plan 2	Active	1/1/26	Family
267	Subscriber	M	1/28/91	79068	Plan 2	Active	1/1/26	Family
267	Spouse	F	5/2/90	79068	Plan 2	Active	1/1/26	Family
267	Dependent	M	3/26/12	79068	Plan 2	Active	1/1/26	Family
267	Dependent	M	7/9/14	79068	Plan 2	Active	1/1/26	Family
267	Dependent	F	2/12/16	79068	Plan 2	Active	1/1/26	Family
267	Dependent	F	12/1/16	79068	Plan 2	Active	1/1/26	Family
268	Subscriber	M	3/11/93	79118	Plan 2	Active	2/9/26	EE only
269	Subscriber	F	8/19/62	79107	Plan 2	Active	1/1/26	EE + Children
269	Dependent	M	2/21/11	79107	Plan 2	Active	1/1/26	EE + Children
270	Subscriber	M	7/28/61	79124	Plan 2	Active	8/31/26	EE + Spouse
270	Spouse	F	2/1/57	79124	Plan 2	Active	8/31/26	EE + Spouse
271	Subscriber	M	9/15/68	79117	Plan 1	Active	1/1/24	EE only
272	Subscriber	M	1/16/88	79118	Plan 1	Active	7/27/26	EE only
273	Subscriber	M	11/14/63	79109	Plan 2	Active	6/30/26	EE + Spouse
273	Spouse	F	12/1/60	79109	Plan 2	Active	1/1/26	EE + Spouse
274	Subscriber	F	9/2/74	79109	Plan 1	Active	8/1/26	EE + Spouse
274	Spouse	M	10/18/71	79109	Plan 1	Active	8/1/26	EE + Spouse
275	Subscriber	M	12/9/72	79110	Plan 2	Active	1/1/26	EE + Spouse
275	Spouse	F	6/26/69	79110	Plan 2	Active	1/1/26	EE + Spouse
276	Subscriber	M	7/12/88	79124	Plan 1	Active	1/1/26	Family
276	Spouse	F	12/6/89	79124	Plan 1	Active	1/1/26	Family
276	Dependent	M	4/26/17	79124	Plan 1	Active	1/1/26	Family
276	Dependent	M	6/7/23	79124	Plan 1	Active	1/1/26	Family
277	Subscriber	M	9/24/92	79124	Plan 1	Active	5/6/26	EE only
278	Subscriber	F	7/5/65	79109	Plan 2	Active	8/10/26	EE only
279	Subscriber	M	6/25/88	79109	Plan 2	Active	9/4/26	Family
279	Spouse	F	11/4/88	79109	Plan 2	Active	9/4/26	Family
279	Dependent	M	8/3/11	79109	Plan 2	Active	1/5/26	Family
279	Dependent	M	11/18/13	79109	Plan 2	Active	1/5/26	Family
279	Dependent	F	2/28/20	79109	Plan 2	Active	1/5/26	Family
280	Subscriber	F	12/8/62	79106	Plan 2	Retiree U65	5/27/24	EE only
281	Subscriber	M	1/22/85	79119	Plan 2	Active	1/29/26	Family
281	Spouse	F	10/27/78	79119	Plan 2	Active	1/1/26	Family
281	Dependent	F	10/15/14	79119	Plan 2	Active	1/1/26	Family
281	Dependent	M	8/23/16	79119	Plan 2	Active	1/29/26	Family
282	Subscriber	M	11/13/87	79106	Plan 1	Active	1/1/26	Family
282	Spouse	F	11/28/90	79106	Plan 1	Active	1/1/26	Family
282	Dependent	M	7/29/09	79106	Plan 1	Active	1/1/26	Family
282	Dependent	M	8/24/12	79106	Plan 1	Active	1/1/26	Family
282	Dependent	M	11/27/17	79106	Plan 1	Active	1/1/26	Family
283	Subscriber	M	10/24/75	79121	Plan 1	Active	1/1/26	EE + Spouse
283	Spouse	F	11/26/81	79121	Plan 1	Active	1/1/26	EE + Spouse
284	Subscriber	F	10/21/70	79109	Plan 2	Active	3/10/25	EE only
285	Subscriber	F	6/6/66	79109	Plan 1	Retiree U65	1/1/26	EE only
286	Subscriber	M	12/16/65	79103	Plan 2	Active	1/1/24	EE only
287	Subscriber	M	2/23/71	79106	Plan 1	Active	1/1/24	EE only
288	Subscriber	M	6/9/77	79104	Plan 2	Active	1/1/26	EE + Children
288	Dependent	F	1/19/08	79104	Plan 2	Active	1/1/26	EE + Children
289	Subscriber	M	10/1/72	79109	Plan 1	Active	7/16/26	EE + Spouse
289	Spouse	F	3/18/65	79109	Plan 1	Active	1/1/26	EE + Spouse
290	Subscriber	F	11/16/76	79107	Plan 1	Active	1/8/26	EE + Children
290	Dependent	F	2/4/09	79107	Plan 1	Active	1/8/26	EE + Children
290	Dependent	F	9/27/11	79107	Plan 1	Active	1/8/26	EE + Children
290	Dependent	F	9/2/14	79107	Plan 1	Active	1/8/26	EE + Children
291	Subscriber	M	6/16/74	79119	Plan 2	Active	1/1/26	Family
291	Spouse	F	11/17/76	79119	Plan 2	Active	1/1/26	Family
291	Dependent	F	11/17/00	79119	Plan 2	Active	1/1/26	Family
291	Dependent	F	9/6/02	79119	Plan 2	Active	1/1/26	Family
292	Subscriber	M	7/14/80	79109	Plan 2	Active	7/17/26	EE + Children
292	Dependent	F	3/31/03	79109	Plan 2	Active	7/17/26	EE + Children
292	Dependent	M	2/19/07	79109	Plan 2	Active	3/2/26	EE + Children
292	Dependent	F	6/21/19	79109	Plan 2	Active	3/2/26	EE + Children
293	Subscriber	M	6/23/75	79015	Plan 1	Active	1/1/26	Family
293	Spouse	F	9/23/76	79015	Plan 1	Active	1/1/26	Family
293	Dependent	F	12/29/07	79015	Plan 1	Active	1/1/26	Family
293	Dependent	M	11/1/11	79015	Plan 1	Active	1/1/26	Family
294	Subscriber	M	3/10/72	79121	Plan 1	Active	9/6/24	Family
294	Spouse	F	8/20/73	79121	Plan 1	Active	9/6/24	Family
294	Dependent	F	1/11/08	79121	Plan 1	Active	4/1/20	Family
295	Subscriber	M	10/25/74	79107	Plan 1	Active	12/5/25	EE + Spouse
295	Spouse	F	2/22/75	79107	Plan 1	Active	12/5/25	EE + Spouse
296	Subscriber	M	11/7/89	79015	Plan 2	Active	5/6/26	EE only
297	Subscriber	F	8/8/77	79088	Plan 1	Active	1/5/26	EE only
298	Subscriber	F	12/28/67	79107	Plan 2	Active	3/31/26	EE + Spouse
298	Spouse	M	1/9/58	79107	Plan 2	Active	1/1/26	EE + Spouse
299	Subscriber	M	5/23/79	79108	Plan 1	Active	2/28/26	Family
299	Spouse	F	8/24/80	79108	Plan 1	Active	1/1/26	Family
299	Dependent	M	6/29/03	79108	Plan 1	Active	1/1/26	Family
299	Dependent	F	4/6/05	79108	Plan 1	Active	1/1/26	Family
300	Subscriber	M	4/7/85	79118	Plan 1	Active	2/26/26	Family
300	Spouse	F	5/2/86	79118	Plan 1	Active	1/1/26	Family
300	Dependent	F	8/9/13	79118	Plan 1	Active	1/1/26	Family
300	Dependent	F	7/2/15	79118	Plan 1	Active	1/1/26	Family
301	Subscriber	M	9/12/74	79119	Plan 1	Active	1/8/26	Family
301	Spouse	F	3/18/80	79119	Plan 1	Active	2/3/25	Family
301	Dependent	F	9/2/08	79119	Plan 1	Active	2/3/25	Family
301	Dependent	F	8/12/16	79119	Plan 1	Active	2/3/25	Family
302	Subscriber	M	7/13/85	79118	Plan 1	Active	6/23/26	Family
302	Spouse	F	11/17/86	79118	Plan 1	Active	6/23/26	Family
302	Dependent	M	12/18/07	79118	Plan 1	Active	4/1/20	Family
302	Dependent	M	12/8/12	79118	Plan 1	Active	4/1/20	Family
302	Dependent	F	9/11/21	79118	Plan 1	Active	1/1/22	Family
303	Subscriber	M	11/2/76	79119	Plan 2	Active	1/1/26	Family
303	Spouse	F	2/10/75	79119	Plan 2	Active	1/1/26	Family
303	Dependent	F	5/28/03	79119	Plan 2	Active	1/1/26	Family
304	Subscriber	M	6/23/83	79118	Plan 1	Active	12/16/24	EE only
305	Subscriber	M	3/16/91	79119	Plan 2	Active	2/28/26	Family
305	Spouse	F	5/1/96	79119	Plan 2	Active	1/1/26	Family
305	Dependent	F	12/22/22	79119	Plan 2	Active	1/1/26	Family
305	Dependent	M	1/29/26	79119	Plan 2	Active	2/28/26	Family
306	Subscriber	M	8/28/91	79015	Plan 2	Active	1/1/26	EE + Children
306	Dependent	M	9/10/07	79015	Plan 2	Active	1/1/26	EE + Children
306	Dependent	F	9/1/09	79015	Plan 2	Active	1/1/26	EE + Children
306	Dependent	M	9/14/15	79015	Plan 2	Active	1/1/26	EE + Children
307	Subscriber	M	8/9/85	79109	Plan 2	Active	8/12/26	Family
307	Spouse	F	12/27/79	79109	Plan 2	Active	1/1/26	Family

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Oct 15, 2026.