Pre-Existing Condition Insurance Plan and Supporting Regulations

OMB 0938-1100

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10339 Proposal Modification Form and Instruction
Form CMS-10339 Record Retention Form and Instruction
Form CMS-10339 Audit Form and Instruction
Form CMS-10339 Audited Financial Report Form and Instruction
Form CMS-10339 Quarterly and Monthly Reporting Form and Instruction
state_solicitation.pdf Supplementary Document
PCIP Model Contract.pdf Supplementary Document
CMS-10339 Supporting_Statement_Part_A.pdf Supporting Statement A
Proposal Modification Form and Instruction
Record Retention Form and Instruction
Audit Form and Instruction
Reports of Insurer Dumping (42 CFR 152.28)
Audited Financial Report Form and Instruction
Quarterly and Monthly Reporting Form and Instruction
Fraud, Waste, and Abuse (42 CFR 152.27)
Payment Invoices (42 CFR 152.32)