EHB Reporting - EHB Actuarial Certificate Template

Essential Health Benefits Benchmark Plans (CMS-10448)

OMB: 0938-1174

IC ID: 229047

Documents and Forms

Document Name Document Type
Form CMS-10488 EHB Reporting - EHB Actuarial Certificate Template Form and Instruction
CMS-10488 EHB Confirmation Template AppA-StateConfirm.pdf Form and Instruction
CMS-10448 EHB Benchmark Plan Certification AppB-EHB-BM-Certif.pdf Form and Instruction
CMS-10448 Benchmark Plans Prescription Template AppD-EHB-BM-PlanRx.pdf Form and Instruction
CMS-10448 Summary of Benefits Template AppC-EHB-BM-2019-BenefSumm-508.pdf Form and Instruction
CMS-10448 EHB Benchmark Plan Certificate CMS-10448_Appendix_B_EHB_Benchmark_Plan_Certificate_508.pdf Form and Instruction
CMS-10448_ Appendix E EHB BM Plans 2019_EHB Chart.pdf Appendix E - Benchmark Plans 2019 EHB Chart - Information Only IC Document