CONTRACT_ID|PLAN_ID|SEGMENT_ID|COVERAGE_LEVEL|TIER|DAYS_SUPPLY|COST_TYPE_PREF|COST_AMT_PREF|COST_MIN_AMT_PREF|COST_MAX_AMT_PREF|COST_TYPE_NONPREF|COST_AMT_NONPREF|COST_MIN_AMT_NONPREF|COST_MAX_AMT_NONPREF|COST_TYPE_MAIL_PREF|COST_AMT_MAIL_PREF|COST_MIN_AMT_MAIL_PREF|COST_MAX_AMT_MAIL_PREF|COST_TYPE_MAIL_NONPREF|COST_AMT_MAIL_NONPREF|COST_MIN_AMT_MAIL_NONPREF|COST_MAX_AMT_MAIL_NONPREF|TIER_SPECIALTY_YN|DED_APPLIES_YN
H0022|001|000|1|1|1|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|1|1|2|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|1|1|4|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|1|2|1|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|1|2|2|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|1|2|4|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|1|3|1|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|1|3|2|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|1|3|4|0|0|0|0|2|0|0|0|0|0|0|0|2|0|0|0|N|N
H0022|001|000|3|1|1|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0022|001|000|3|1|2|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0022|001|000|3|1|4|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0022|001|000|3|2|1|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0022|001|000|3|2|2|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0022|001|000|3|2|4|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0022|001|000|3|3|1|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0022|001|000|3|3|2|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0022|001|000|3|3|4|2|0|0|0|2|0|0|0|2|0|0|0|2|0|0|0|N|N
H0028|007|000|1|1|1|0|0|0|0|2|0.25|0|4.9|0|0|0|0|2|0.25|0|4.9|N|Y
H0028|007|000|1|1|2|0|0|0|0|2|0.25|0|4.9|0|0|0|0|2|0.25|0|4.9|N|Y
H0028|007|000|1|2|1|0|0|0|0|2|0.25|0|12.15|0|0|0|0|2|0.25|0|12.15|N|Y
H0028|007|000|1|2|2|0|0|0|0|2|0.25|0|12.15|0|0|0|0|2|0.25|0|12.15|N|Y
H0028|007|000|1|3|1|0|0|0|0|2|0.25|0|12.15|0|0|0|0|2|0.25|0|12.15|N|Y
H0028|007|000|1|3|2|0|0|0|0|2|0.25|0|12.15|0|0|0|0|2|0.25|0|12.15|N|Y
H0028|007|000|1|4|1|0|0|0|0|2|0.25|0|12.15|0|0|0|0|2|0.25|0|12.15|N|Y
H0028|007|000|1|4|2|0|0|0|0|2|0.25|0|12.15|0|0|0|0|2|0.25|0|12.15|N|Y
H0028|007|000|1|5|1|0|0|0|0|2|0.25|0|12.15|0|0|0|0|2|0.25|0|12.15|N|Y
H0028|007|000|1|5|2|0|0|0|0|2|0.25|0|12.15|0|0|0|0|2|0.25|0|12.15|N|Y
H0028|007|000|3|1|1|1|0|0|4.9|1|0|0|4.9|1|0|0|4.9|1|0|0|4.9|N|Y
H0028|007|000|3|1|2|1|0|0|4.9|1|0|0|4.9|1|0|0|4.9|1|0|0|4.9|N|Y
H0028|007|000|3|1|4|1|0|0|4.9|1|0|0|4.9|1|0|0|4.9|1|0|0|4.9|N|Y
H0028|007|000|3|2|1|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|2|2|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|2|4|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|3|1|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|3|2|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|3|4|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|4|1|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|4|2|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|4|4|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|5|1|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|5|2|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|007|000|3|5|4|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|1|0|0|12.15|N|Y
H0028|014|000|0|1|1|0|0|0|0|1|0|0|0|1|0|0|0|1|10|0|0|N|N
H0028|014|000|0|1|2|0|0|0|0|1|0|0|0|1|0|0|0|1|30|0|0|N|N
H0028|014|000|0|2|1|0|0|0|0|1|5|0|0|1|5|0|0|1|20|0|0|N|N
H0028|014|000|0|2|2|0|0|0|0|1|15|0|0|1|0|0|0|1|60|0|0|N|N
H0028|014|000|0|3|1|0|0|0|0|1|47|0|0|1|47|0|0|1|47|0|0|N|N
H0028|014|000|0|3|2|0|0|0|0|1|141|0|0|1|131|0|0|1|141|0|0|N|N
H0028|014|000|1|1|1|0|0|0|0|1|0|0|0|1|0|0|0|1|10|0|0|N|N
