Crosswalk Part D EOB - 30day

Part D Model EOB Crosswalk
60 Day Comment version

30 Day Comment version

Type of
Change

Reason for change

Consolidated and removed from pages 2, 3,
and 4

Rev

Clarity

Moved Chart 1a to page 2 of exhibit
Added Section Break

Rev

Visibility

Moved to page 3

Rev

Visibility

Moved to page 5 of exhibit

Rev

Clarity, consistency

Throughout:
Terms and Definitions for:
Out-of-pocket costs include
You Paid
Plan Paid
Out-of-pocket costs DON’T include
payments made for
Other Payments
Chart 1a on page 3

Chart 2 on page 4

Placement of grey information box:
See the next page for places to get help
& more information about your options
on page 6

Burden
Change
No

Moved to page 6 of exhibit
Added section break to page 6 for
definitions

Added Section Break

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.

No

No

No

60 Day Comment version

30 Day Comment version

Type of
Change

Reason for Change

Burden
Change

Placement of information and
display of:

Consolidated with Glossary
Terms and Definitions, moved to page 5

Rev

Clarity, consistency

No

About Coverage Stages

Added Section Break

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This pre-decisional, privileged, and confidential
information is for internal government use only, and must not be disseminated, distributed, or copied to persons not authorized to
receive the information. For Preliminary discussion only, pending review of all public comments. Unauthorized disclosure may result in
prosecution to the full extent of the law.

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.