CMS-R-262 General Setup

CMS Plan Benefit Package (PBP) and Formulary CY 2026 (CMS-R-262) - IRA

Appendix_C_PBP2026 General Setup

CY2026 Plan Benefit Package (PBP) Software and Formulary Submission

OMB: 0938-0763

Document [pdf]
Download: pdf | pdf
CY 2026 PBP Data Entry System Screens
Plan Benefit Package Landing Page

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 41

CY 2026 PBP Data Entry System Screens
Plan Characteristics – Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 41

CY 2026 PBP Data Entry System Screens
Plan Characteristics – Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 41

CY 2026 PBP Data Entry System Screens
Plan Characteristics – Page 3

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 41

CY 2026 PBP Data Entry System Screens
Plan Characteristics – Page 4

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 41

CY 2026 PBP Data Entry System Screens
Standard Bid

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 41

CY 2026 PBP Data Entry System Screens
Benefit Offerings – Medicare Services

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 41

CY 2026 PBP Data Entry System Screens
Benefit Offerings – Non-Medicare Services

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 10 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Page 3

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 11 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Page 4

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 12 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Page 5

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 15 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 3

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 16 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 4

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 17 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Plan Deducible – Page 5

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 18 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 19 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 20 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 3

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 21 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 4

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 22 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 5

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 23 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Max Enrollee Cost Limit – Page 6

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Deductible– Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Deductible– Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 26 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Deductible – Page 3

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 27 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Differential Service Category Deductibles (LPPO/RPPO) – Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 28 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Differential Service Category Deductibles (LPPO/RPPO) – Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 29 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Deductible for LPPO/RPPO Mandatory Supplemental Benefits – Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 30 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – Deductible for LPPO/RPPO Mandatory Supplemental Benefits – Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 31 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 32 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 33 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 3

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 34 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 4

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 35 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 5

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 36 of 41

CY 2026 PBP Data Entry System Screens
Plan Level Cost Sharing – LPPO/RPPO Max Enrollee Cost Limit – Page 6

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 37 of 41

CY 2026 PBP Data Entry System Screens
Prior Authorization and Referral – Prior Authorization – Page 1

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 38 of 41

CY 2026 PBP Data Entry System Screens
Prior Authorization and Referral – Prior Authorization – Page 2

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 39 of 41

CY 2026 PBP Data Entry System Screens
Prior Authorization and Referral – Referral

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 40 of 41

CY 2026 PBP Data Entry System Screens
Visitor Travel

Softrams

CY2026 PBP – General Setup
01/08/2025
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 41 of 41


File Typeapplication/pdf
File TitleCY 2026 PBP Data Entry System Screens
AuthorCMS
File Modified2024-12-19
File Created2024-12-19

© 2025 OMB.report | Privacy Policy