Eob

The Medicare Advantage and Prescription Drug Program: Part C Explanation of Benefits and Supporting Regulations (CMS-10453) - IRA

OMB: 0938-1228

IC ID: 208197

Documents and Forms

Document Name Document Type
Form CMS-10453 EOB Form and Instruction
CMS-10453 HMO Monthly Template Appendix A. MA HMO monthly template.pdf Form and Instruction
CMS-10453 HMO Quarterly Template Appendix A. MA HMO quarterly template.pdf Form and Instruction
CMS-10453 MSA Monthly Template Appendix A. MA MSA monthly template.pdf Form and Instruction
CMS-10453 MSA Quarterly Template Appendix A. MA MSA quarterly template.pdf Form and Instruction
CMS-10452 PFFS monthly Template Appendix A. MA PFFS monthly template.pdf Form and Instruction
CMS-10453 PFFS quarterly Template Appendix A. MA PFFS quarterly template.pdf Form and Instruction
CMS-10453 PPO Monthly Template Appendix A. MA PPO monthly template.pdf Form and Instruction
CMS-10453 PPO Quarterly Template Appendix A. MA PPO quarterly template.pdf Form and Instruction
Appendix B. CY 2025 Part D EOB Exhibit A.pdf Instruction
Appendix B. CY 2025 Part D EOB Exhibit B.pdf Instruction
Appendix B. CY 2025 Part D EOB Exhibit C.pdf Instruction
Appendix B. CY 2025 Part D EOB Exhibit D.pdf Instruction
Appendix B. CY 2025 Part D EOB Exhibit E.pdf Instruction
Appendix B. CY 2025 Part D EOB Exhibit F.pdf Instruction
Appendix B. CY 2025 Part D EOB Exhibit G.pdf Instruction
CMS-10453 Part D EOB Plan Instructions Appendix B. CY 2025 EOB Plan Instructions.pdf Form and Instruction