The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
Appendix C - PBP_2008_screenshots_sec_b18
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
OMB: 0938-0763
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0763 can be found here:
Document [doc]
Download: doc | pdf
PBP 2008 Data Entry System Screens
Section B – 18a – Hearing Exams – Base 1 Screen
Section B – 18a – Hearing Exams – Base 2 Screen
Section B – 18a – Hearing Exams – Base 3 Screen
Section B – 18a – Hearing Exams – Base 4 Screen
Section B – 18a – Hearing Exams – Base 5 Screen
Section B – 18b – Hearing Aids – Base 1 Screen
Section B – 18b – Hearing Aids – Base 2 Screen
Section B – 18b – Hearing Aids – Base 3 Screen
Section B – 18b – Hearing Aids – Base 4 Screen
Section B – 18b – Hearing Aids – Base 5 Screen
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| File Type | application/msword |
| File Modified | 2006-12-20 |
| File Created | 2006-12-20 |
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