CMS-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_PBP2023_Screenshots-SectionB-VBID-UF-SSBCI-2021-12-27

CY2023 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

OMB: 0938-0763

Document [pdf]
Download: pdf | pdf
#19 VBID/MA Uniformity Flexibility/SSBCI

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CY 2023 PBP Data Entry System Screens

CY2023 PBP – Section B VBID/UF/SSBCI
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CY 2023 PBP Data Entry System Screens

#19 VBID Wellness and Health Care Planning

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CY 2023 PBP Data Entry System Screens

#19 VBID Part C Rewards and Incentives # 1

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#19 VBID Part C Rewards and Incentives # 2

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#19 VBID Part C Rewards and Incentives # 3

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#19a VBID- Cash or Monetary Rebates

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CY2023 PBP – Section B VBID/UF/SSBCI
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#19a Reduction in Costs VBID/UF/SSBCI

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CY2023 PBP – Section B VBID/UF/SSBCI
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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Package Type

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CY2023 PBP – Section B VBID/UF/SSBCI
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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Target Population: VBID

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

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#19a Additional Benefits for VBID/UF/SSBCI – Chronic Conditions: SSBCI

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CY2023 PBP – Section B VBID/UF/SSBCI
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#19a Reduced Cost Sharing for VBID/UF/SSBCI – MMP Benefits

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

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 2 (OON/POS/Plan-level Deductible)

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CY 2023 PBP Data Entry System Screens

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

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

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

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

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

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 8 (Reduced Deductible)

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

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

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

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

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

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

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

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12/27/2021
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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 16 (Reduced Specialist Deductible)

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

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#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 18 (Maximum Aggregate Amount)

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

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#19b Additional Benefits for VBID/UF/SSBCI

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#19b Additional Benefits for VBID/UF/SSBCI – Package Type

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#19b Additional Benefits for VBID/UF/SSBCI – Target Population: VBID

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

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#19b Additional Benefits for VBID/UF/SSBCI – Chronic Conditions: SSBCI (New Screen CY2022)

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#19b Additional Benefits for VBID/UF/SSBCI – MMP Benefits

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

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

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#19b Additional Benefits for VBID/UF/SSBCI – Base 3 (Maximum Aggregate Amount)

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#19b Additional Benefits for VBID/UF/SSBCI - Notes

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#19c VBID Hospice- Base 1

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CY2023 PBP – Section B VBID/UF/SSBCI
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#19c VBID Hospice- Base 2

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CY2023 PBP – Section B VBID/UF/SSBCI
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#19c VBID Hospice- Base 3

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CY2023 PBP – Section B VBID/UF/SSBCI
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#19c VBID Hospice- Base 4

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CY2023 PBP – Section B VBID/UF/SSBCI
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CY 2023 PBP Data Entry System Screens

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

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

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

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VBID/UF/SSBCI 19B #10b Transportation Services – Base 2

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File TitleCY 2023 PBP Section B VBID UF SSBCI
AuthorCMS
File Modified2021-12-13
File Created2021-12-10

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