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For Clinical Appropriateness Formulary Outlier and EHB Category/Class Benchmark Count reviews complete the Combined Non-Discrimination Formulary Review Supporting Documentation and Justification. Date Health Insurance Oversight System HIOS Issuer ID State HIOS Plan IDs Medical Condition Justification for Benefit Design If you do not have enough space here to list your justifications print out another form to augment them as needed. PY-18 Version 1 2018 QHP Application Instructions....

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Discrimination treatment protocol supporting focuses on promoting equal treatment and preventing discrimination.

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Discrimination treatment protocol supporting must include details on the organization's policies, procedures, and practices related to preventing discrimination.

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