R-262 VBID – General

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

APPENDIX_C_PBP2020-Screenshots-Section-Rx-VBID-2018-12-12

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

OMB: 0938-0763

Document [pdf]
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CY 2020 PBP Data Entry System Screens
VBID – General

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 26

CY 2020 PBP Data Entry System Screens
VBID – Package Setup

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 26

CY 2020 PBP Data Entry System Screens
VBID – Package Tiers – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 26

CY 2020 PBP Data Entry System Screens
VBID – Tier Coverage – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 26

CY 2020 PBP Data Entry System Screens
VBID – Tier Locations – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 26

CY 2020 PBP Data Entry System Screens
VBID – Retail Copayment – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 26

CY 2020 PBP Data Entry System Screens
VBID – Retail Coinsurance – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 26

CY 2020 PBP Data Entry System Screens
VBID – Mail Order Copayment – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 26

CY 2020 PBP Data Entry System Screens
VBID – Mail Order Coinsurance – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 26

CY 2020 PBP Data Entry System Screens
VBID – Out-of-Network and LTC Cost Sharing – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 10 of 26

CY 2020 PBP Data Entry System Screens
VBID – Daily Retail and Mail Order Copay – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 11 of 26

CY 2020 PBP Data Entry System Screens
VBID – Daily LTC Copay – Pre-ICL

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 12 of 26

CY 2020 PBP Data Entry System Screens
VBID – Package Tiers – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 26

CY 2020 PBP Data Entry System Screens
VBID – Tier Coverage – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 26

CY 2020 PBP Data Entry System Screens
VBID – Tier Locations – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 15 of 26

CY 2020 PBP Data Entry System Screens
VBID – Retail Copayment – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 16 of 26

CY 2020 PBP Data Entry System Screens
VBID – Retail Coinsurance – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 17 of 26

CY 2020 PBP Data Entry System Screens
VBID – Mail Order Copayment – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 18 of 26

CY 2020 PBP Data Entry System Screens
VBID – Mail Order Coinsurance – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 19 of 26

CY 2020 PBP Data Entry System Screens
VBID – Out-of-Network and LTC Cost Sharing – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 20 of 26

CY 2020 PBP Data Entry System Screens
VBID – Daily Retail and Mail Order Copay – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 21 of 26

CY 2020 PBP Data Entry System Screens
VBID – Daily LTC Copay – Gap

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 22 of 26

CY 2020 PBP Data Entry System Screens
VBID – Package Tiers – OOP Threshold

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 23 of 26

CY 2020 PBP Data Entry System Screens
VBID – Tier Coverage – OOP Threshold

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 26

CY 2020 PBP Data Entry System Screens
VBID – Post OOP Threshold Cost Sharing

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 26

CY 2020 PBP Data Entry System Screens
VBID – Package notes

Softrams

CY2020 PBP – Section Rx VBID
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 26 of 26

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

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