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CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 41
Plan Characteristics – Page 1
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 41
Plan Characteristics – Page 2
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 41
Plan Characteristics – Page 3
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 41
Plan Characteristics – Page 4
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 41
Standard Bid
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 41
CY 2025 PBP Data Entry System Screens
Benefit Offerings – Medicare Services
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 41
CY 2025 PBP Data Entry System Screens
Benefit Offerings – Non-Medicare Services
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 41
Plan Level Cost Sharing – Page 1
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 41
Plan Level Cost Sharing – Page 2
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 41
Plan Level Cost Sharing – Page 3
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 41
Plan Level Cost Sharing – Page 4
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 41
Plan Level Cost Sharing – Page 5
Softrams
CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 1
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 2
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 3
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 4
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 5
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 1
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 2
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 3
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 4
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 5
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 6
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Deductible– Page 1
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Deductible– Page 2
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Deductible – Page 3
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Differential Service Category Deductibles (LPPO/RPPO) – Page 1
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Differential Service Category Deductibles (LPPO/RPPO) – Page 2
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Deductible for LPPO/RPPO Mandatory Supplemental Benefits – Page 1
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – Deductible for LPPO/RPPO Mandatory Supplemental Benefits – Page 2
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 1
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 2
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 3
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 4
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 5
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 41
CY 2025 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 6
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 41
CY 2025 PBP Data Entry System Screens
Prior Authorization and Referral – Prior Authorization – Page 1
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 41
CY 2025 PBP Data Entry System Screens
Prior Authorization and Referral – Prior Authorization – Page 2
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 39 of 41
CY 2025 PBP Data Entry System Screens
Prior Authorization and Referral – Referral
Softrams
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 40 of 41
Visitor Travel
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CY 2025 PBP Data Entry System Screens
CY2025 PBP – General Setup
12/29/2023
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 41 of 41
| File Type | application/pdf |
| File Title | CY 2025 PBP Data Entry System Screens |
| Author | CMS |
| File Modified | 2023-12-19 |
| File Created | 2023-12-19 |