CMS-R-262 CY 2019 PBP Data Entry System Screens - Section A and Up

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

Appendix_C_PBP_2019_ screenshots_section_a_and_upload_2017_11_17

CY2019 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⚠️ Notice: This form may be outdated.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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Section A-1

Fu Associates, Ltd.

CY 2019 PBP Data Entry System Screens

CY2019 PBP – Section A
11/17/2017
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 8

Section A-2

Fu Associates, Ltd.

CY 2019 PBP Data Entry System Screens

CY2019 PBP – Section A
11/17/2017
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 8

Section A-3

Fu Associates, Ltd.

CY 2019 PBP Data Entry System Screens

CY2019 PBP – Section A
11/17/2017
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 8

Section A-4

Fu Associates, Ltd.

CY 2019 PBP Data Entry System Screens

CY2019 PBP – Section A
11/17/2017
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 8

Section A-5

Fu Associates, Ltd.

CY 2019 PBP Data Entry System Screens

CY2019 PBP – Section A
11/17/2017
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 8

Section A-6

Fu Associates, Ltd.

CY 2019 PBP Data Entry System Screens

CY2019 PBP – Section A
11/17/2017
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 8

Section A-7

Fu Associates, Ltd.

CY 2019 PBP Data Entry System Screens

CY2019 PBP – Section A
11/17/2017
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 8

PBP Plan Upload

Fu Associates, Ltd.

CY 2019 PBP Data Entry System Screens

CY2019 PBP – Section A
11/17/2017
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 8

File Type	application/pdf
File Title	CY 2019 PBP Data Entry System Screens - Section A
Author	Michelle Hsu
File Modified	2017-11-29
File Created	2017-11-29