Crosswalk

Consolidated into H9999-001

CMS file crosswalk_2027.csv, row 2: Consolidated Renewal Plan

Flagged for review

Why

  • Plan consolidated into H9999-001

The 15 fields, side by side

Field20262027ChangeCategory
Monthly premium

$25.50 a month

H9999-002_2026_SB, page 1

$25.00 a month

H9999-001_2027_SB, page 1

DownPremium
Medical deductible

$250.00 a year

H9999-002_2026_SB, page 1

$0.00 a year

H9999-001_2027_SB, page 1

DownDeductible
Maximum out-of-pocket (in network)

$6,700.00 a year

H9999-002_2026_SB, page 1

$4,900.00 a year

H9999-001_2027_SB, page 1

DownMaximum out-of-pocket
Primary care visit

$5.00 copay a visit

H9999-002_2026_SB, page 1

$0.00 copay a visit

H9999-001_2027_SB, page 1

DownCopays
Specialist visit

$45.00 copay a visit

H9999-002_2026_SB, page 1

$45.00 copay a visit

H9999-001_2027_SB, page 1

No changeCopays
Emergency room

$110.00 copay a visit

H9999-002_2026_SB, page 1

$125.00 copay a visit

H9999-001_2027_SB, page 1

UpCopays
Urgent care

$35.00 copay a visit

H9999-002_2026_SB, page 1

$40.00 copay a visit

H9999-001_2027_SB, page 1

UpCopays
Inpatient hospital stay

$295.00 copay a day

H9999-002_2026_SB, page 1

$325.00 copay a day

H9999-001_2027_SB, page 1

UpCopays
Outpatient surgery

$200.00 copay a visit

H9999-002_2026_SB, page 2

$250.00 copay a visit

H9999-001_2027_SB, page 2

UpCopays
Drug deductible

$200.00 a year

H9999-002_2026_SB, page 2

$0.00 a year

H9999-001_2027_SB, page 2

DownDrugs
Drug tier 1

$2.00 copay a prescription

H9999-002_2026_SB, page 2

$0.00 copay a prescription

H9999-001_2027_SB, page 2

DownDrugs
Drug tier 2

$10.00 copay a prescription

H9999-002_2026_SB, page 2

$8.00 copay a prescription

H9999-001_2027_SB, page 2

DownDrugs
Drug tier 3

$45.00 copay a prescription

H9999-002_2026_SB, page 2

$47.00 copay a prescription

H9999-001_2027_SB, page 2

UpDrugs
Dental allowance

$1,500.00 a year

H9999-002_2026_SB, page 2

$2,000.00 a year

H9999-001_2027_SB, page 2

UpAllowances
Over-the-counter allowance

$150.00 a year

H9999-002_2026_SB, page 2

$50.00 a quarter

H9999-001_2027_SB, page 2

UpAllowances

Review items for this plan

  • MediumCannot be checked against CMSDental allowance, 2026

    PDF says $1,500.00 per year, CMS says $1,500.00 (period not comparable)

    H9999-002_2026_SB, page 2CMS file pbp_b16_dental.txt, row 2

  • MediumCannot be checked against CMSOver-the-counter allowance, 2026

    PDF says $150.00 per year, CMS says $150.00 (period not comparable)

    H9999-002_2026_SB, page 2CMS file pbp_b13_other_services.txt, row 2