CMS-R-262 CY 2016 PBP Data Entry System Screens (section C)

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs) (CMS-R-262)

Appendix_C_PBP_2016_ screenshots_section_c_2014_12_05

CY2016 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⚠️ Notice: This form may be outdated.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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OON – General – Base 1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 29

OON – General – Base 2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 29

OON – General – Notes

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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OON – Inpatient – Base 1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 29

OON – Inpatient – Base 2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 29

OON – Inpatient – Base 3

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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OON – Inpatient – Base 4

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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OON – SNF – Base 1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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OON – SNF – Base 2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 29

OON – Number of Groups

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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OON – Groups – Base 1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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OON – Groups – Base 2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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POS – General – Base 1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 29

POS – General – Base 2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 29

POS – General – Base 3

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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POS – General – Base 4

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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POS – General – Base 5

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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POS – General – Base 6

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 18 of 29

POS – Inpatient – Base 1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 19 of 29

POS – Inpatient – Base 2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 20 of 29

POS – Inpatient – Base 3

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 21 of 29

POS – Inpatient – Base 4

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 22 of 29

POS – Inpatient – Base 5

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 23 of 29

POS – SNF – Base 1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 29

POS – SNF – Base 2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 29

POS – Number of Groups

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 26 of 29

POS – Groups – Base 1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 27 of 29

POS – Groups – Base 2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 28 of 29

V/T – General – US

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section C
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 29 of 29
File Type	application/pdf
File Title	CY 2016 PBP Data Entry System Screens
Author	Scott Meyer
File Modified	2014-12-05
File Created	2014-12-05