R-262 #19 VBID/MA Uniformity Flexibility/SSBCI

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

APPENDIX_C_PBP2020_Screenshots-SectionB-VBID-UF-SSBCI-2018-12-12

CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

OMB: 0938-0763

Document [pdf]
Download: pdf | pdf
CY 2020 PBP Data Entry System Screens
#19 VBID/MA Uniformity Flexibility/SSBCI

Softrams

CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduction in Costs VBID/UF/SSBCI

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Package Type

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Disease States: VBID

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Disease States: UF

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – MMP Benefits

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 1 (Package Info)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 2 (OON/POS/Plan-level Deductible)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 3 (Reduced Coinsurance)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 4 (Reduced Coinsurance)

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12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 5 (Reduced Coinsurance)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 6 (Reduced Coinsurance)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 7 (Reduced Coinsurance)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 8 (Reduced Deductible)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 9 (Reduced Deductible)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 10 (Reduced Copayment)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 11 (Reduced Copayment)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 12 (Reduced Copayment)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 13 (Reduced Copayment)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 14 (Reduced Copayment)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 15 (Reduced Specialist Coinsurance)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 16 (Reduced Specialist Deductible)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 17 (Reduced Specialist Copayment)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 18 (Retroactive Reimbursement)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Notes

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 1

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 2

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 3

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 4

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 5

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 6

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 7

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12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 8

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 9

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 10

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 11

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 12

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 1

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 2

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 3

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 4

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 5

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 6

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 7

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 8

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 9

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 10

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 11

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 12

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 1

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19A #2 SNF – Base 2

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 3

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 4

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 5

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 6

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 7

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 8

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 9

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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VBID/UF/SSBCI 19A #2 SNF – Base 10

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19b Additional Benefits for VBID/UF/SSBCI

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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#19b Additional Benefits for VBID/UF/SSBCI – Package Type

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19b Additional Benefits for VBID/UF/SSBCI – Disease States: VBID

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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#19b Additional Benefits for VBID/UF/SSBCI – Disease States: UF

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CY2020 PBP – Section B VBID/UF/SSBCI
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#19b Additional Benefits for VBID/UF/SSBCI – MMP Benefits

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CY2020 PBP – Section B VBID/UF/SSBCI
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#19b Additional Benefits for VBID/UF/SSBCI – Base 1 (Package Info)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19b Additional Benefits for VBID/UF/SSBCI – Base 2 (OON/POS/Plan-level Deductible)

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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

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#19b Additional Benefits for VBID/UF/SSBCI – Base 3 (Retroactive Reimbursement)

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12/12/2018
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#19b Additional Benefits for VBID/UF/SSBCI – Notes

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VBID/UF/SSBCI 19B #2 SNF – Base 1

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VBID/UF/SSBCI 19B #9d Outpatient Blood Services – Base 1

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VBID/UF/SSBCI 19B #10b Transportation Services – Base 1

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File Typeapplication/pdf
File TitleCY 2020 PBP Data Entry System Screens
AuthorScott Meyer
File Modified2018-12-18
File Created2018-12-12

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