CMS-10433 Network ID Template

OMB Control Number: 0938-1187
Expiration Date: XX/XX/20XX
HIOS Issuer ID:
GENERATED 2022-01-19T13:50:38
URLs can be edited only with the New URL column (cannot be changed by making edits to the Current URL column). For more details and instructions please reference the user guide that can be downloaded from the UI.
URL Type
URL ID Market Type Product Type Current URL New URL Current Technical POC Email
New Technical POC Email
Machine-Readable
N/A
N/A
Transparency in Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Summary of Benefits and Coverage
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Plan Brochure
N/A
N/A
N/A
N/A
Payment
N/A
N/A
N/A
N/A
Payment
N/A
N/A
N/A
N/A
Network
N/A
N/A
N/A
N/A
Network
N/A
N/A
N/A
N/A
Formulary
N/A
N/A
N/A
N/A
Formulary
N/A
N/A
N/A
N/A

PRA DISCLOSURE:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection
is 0938-1187, expiration date is XX/XX/20XX. The time required to complete this information collection is estimated to take up to 24.50 hours per issuer per year, including the time to review instructions, gather the information
needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn:
PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical records or any documents containing sensitive
information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be
reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact Nicole Levesque at [email protected].