CMS-R-262 CY 2018 PBP Data Entry System Screens - Section D

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

Appendix_C_PBP_2018_ screenshots_section_d_2016_12_02_508

CY2018 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

OMB: 0938-0763

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Plan Deductible LPPO/RPPO Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section D
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Plan Deductible LPPO/RPPO Base 2

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Plan Deductible LPPO/RPPO Base 3

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CY 2018 PBP Data Entry System Screens

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Plan Deductible LPPO/RPPO Base 4

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CY 2018 PBP Data Entry System Screens

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Plan Deductible LPPO/RPPO Base 5

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Plan Deductible LPPO/RPPO Base 6

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Deductible for LPPO/RPPO Mandatory Supplemental Benefits – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Deductible for LPPO/RPPO Mandatory Supplemental Benefits – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section D
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Plan Deductible (In-Network)

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Plan Deductible (Combined) – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Plan Deductible (Combined) – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section D
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Plan Deductible (Out-of-Network)

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Plan Deductible (Non-Network)

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section D
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Max Enrollee Cost Limit (In-Network)

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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CY 2018 PBP Data Entry System Screens

Max Enrollee Cost Limit (Combined) – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Max Enrollee Cost Limit (Combined) – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section D
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Max Enrollee Cost Limit (Out-of-Network)

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section D
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Max Enrollee Cost Limit (Non-Network)

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section D
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Max Plan Benefit Coverage

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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CY 2018 PBP Data Entry System Screens

Max Plan Benefit Coverage (Non-Network)

Fu Associates, Ltd.

CY2018 PBP – Section D
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Plan Premium/Rebate Reduction

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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CY 2018 PBP Data Entry System Screens

MMP – Medicaid/plan covered cost sharing

Fu Associates, Ltd.

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PFFS Balance Billing

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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MSA Annual Deductible/Deposit

Fu Associates, Ltd.

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Notes

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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CY 2018 PBP Data Entry System Screens

Optional Supplemental – Management Screen

Fu Associates, Ltd.

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Optional Supplemental – Label and Premium

Fu Associates, Ltd.

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CY 2018 PBP Data Entry System Screens

Optional Supplemental – Service Categories

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Optional Supplemental – OON Optional

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Optional Supplemental – OON Step-up

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CY 2018 PBP Data Entry System Screens

Step-up #7b Chiropractic Services – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Step-up #7b Chiropractic Services – Base 2

Fu Associates, Ltd.

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CY 2018 PBP Data Entry System Screens

Step-up #7b Chiropractic Services – Base 3

Fu Associates, Ltd.

CY2018 PBP – Section D
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Step-up #7f Podiatry Services – Base 1

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CY 2018 PBP Data Entry System Screens

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Step-up #7f Podiatry Services – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #7f Podiatry Services – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Step-up #10b Transportation Services – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Step-up #10b Transportation Services – Base 2

Fu Associates, Ltd.

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CY 2018 PBP Data Entry System Screens

Step-up #10b Transportation Services – Base 3

Fu Associates, Ltd.

CY2018 PBP – Section D
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Step-up #16a Preventive Dental – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #16a Preventive Dental – Base 2

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CY 2018 PBP Data Entry System Screens

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Step-up #16a Preventive Dental – Base 3

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CY 2018 PBP Data Entry System Screens

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Step-up #16a Preventive Dental – Base 4

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #16a Preventive Dental – Base 5

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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CY 2018 PBP Data Entry System Screens

Step-up #16b Comprehensive Dental – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Step-up #16b Comprehensive Dental – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section D
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CY 2018 PBP Data Entry System Screens

Step-up #16b Comprehensive Dental – Base 3

Fu Associates, Ltd.

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CY 2018 PBP Data Entry System Screens

Step-up #16b Comprehensive Dental – Base 4

Fu Associates, Ltd.

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CY 2018 PBP Data Entry System Screens

Step-up #16b Comprehensive Dental – Base 5

Fu Associates, Ltd.

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CY 2018 PBP Data Entry System Screens

Step-up #16b Comprehensive Dental – Base 6

Fu Associates, Ltd.

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Step-up #17a Eye Exams – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #17a Eye Exams – Base 2

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Step-up #17a Eye Exams – Base 3

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Step-up #17b Eyewear – Base 1

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Step-up #17b Eyewear – Base 2

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Step-up #17b Eyewear – Base 3

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Step-up #17b Eyewear – Base 4

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CY 2018 PBP Data Entry System Screens

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Step-up #17b Eyewear – Base 5

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #17b Eyewear – Base 6

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #18a Hearing Exams – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #18a Hearing Exams – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #18a Hearing Exams – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #18a Hearing Exams – Base 4

Fu Associates, Ltd.

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Step-up #18b Hearing Aids – Base 1

Fu Associates, Ltd.

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Step-up #18b Hearing Aids – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #18b Hearing Aids – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #18b Hearing Aids – Base 4

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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Step-up #18b Hearing Aids – Base 5

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

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File Typeapplication/pdf
File TitleCY 2018 PBP Data Entry System Screens - Section D
AuthorScott Meyer
File Modified2017-01-03
File Created2017-01-03

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