CMS-R-262 PBP 2015 Data Entry System (section A screen shots)

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

Appendix_C_PBP_2015_screenshots_section_a_2013_11_20

CY2013 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

OMB: 0938-0763

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0763 can be found here:

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PBP	2015	Data	Entry	System	Screens	
 
Section A‐1 

 
Fu Associates, Ltd.

 
 

CY 2015 PBP – Section A
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 6

PBP	2015	Data	Entry	System	Screens	
 
Section A‐2 

 
Fu Associates, Ltd.

 
 

CY 2015 PBP – Section A
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 6

PBP	2015	Data	Entry	System	Screens	
 
Section A‐3 

 
Fu Associates, Ltd.

 
 

CY 2015 PBP – Section A
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 6

PBP	2015	Data	Entry	System	Screens	
 
Section A‐4 

 
Fu Associates, Ltd.

 
 

CY 2015 PBP – Section A
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 6

PBP	2015	Data	Entry	System	Screens	
 
Section A‐5 

 
Fu Associates, Ltd.

 
 

CY 2015 PBP – Section A
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 6

PBP	2015	Data	Entry	System	Screens	
 
Section A‐6 

 
Fu Associates, Ltd.

 
 

CY 2015 PBP – Section A
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 6

File Type	application/pdf
File Title	Microsoft Word - PBP_2015_screenshots_section_a_2013_11_20.docx
Author	bloss
File Modified	2013-12-20
File Created	2013-12-20