Document Name Document Type
Form CMS-10433 QHP Certification Form and Instruction
CMS-10433 Appendix A 1 Issuer data elements 8 - Appendix A 1 Issuer data elements.pdf Form and Instruction
CMS-10433 Appendix A 2 Program Attestations 9 - Appendix A 2 Program Attestations.pdf Form and Instruction
CMS-10433 Appendix A 3 AdministrativeData Template 10 - Appendix A 3 AdministrativeData Template.xls Form and Instruction
CMS-10433 Appendix A 4 EssentialCommunityProviders Template 11 - Appendix A 4 EssentialCommunityProviders Template.xls Form and Instruction
CMS-10433 IssuerURAC 12 - IssuerURAC.xls Form and Instruction
CMS-10433 IssuersNCQA 12 - IssuersNCQA.xls Form and Instruction
CMS-10433 Appendix A 6 Network Adequacy Template 13 - Appendix A 6 Network Adequacy Template.xls Form and Instruction
CMS-10433 Appendix B 1 QHP Benefit Elements 14 - Appendix B 1 QHP Benefit Elements.pdf Form and Instruction
CMS-10433 PlansBenefits 15-PlansBenefits.xlsm Form and Instruction
CMS-10433 PlansBenefitsAddIn 15 - PlansBenefitsAddIn.xlam Form and Instruction
CMS-10433 Appendix B 3 PrescriptionDrug Template 16 - Appendix B 3 PrescriptionDrug Template.xls Form and Instruction
CMS-10433 Appendix B 4 ServiceArea Template 17 - Appendix B 4 ServiceArea Template.xls Form and Instruction
CMS-10433 Appendix C 1 Rating Tables and Issuer Business Rules 18 - Appendix C 1 Rating Tables and Issuer Business Rules .pdf Form and Instruction
CMS-10433 Appendix C 2 RateTables Template 19 - Appendix C 2 RateTables Template.xls Form and Instruction
CMS-10433 Appendix C 3 RatingBusinessRules Template 20 - Appendix C 3 RatingBusinessRules Template.xls Form and Instruction

            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.