Plan Benefit Materials | Ascension Complete

Plan Materials and Forms

 

Listed below are some documents that may be helpful at different times during your membership. 

This booklet gives you a summary of costs and coverage in your plan. Please select the document for your plan and county:
 

Florida - Sacred Heart and St. Vincent's

Plan Name CMS # County Summary of Benefits
Ascension Complete St. Vincent's Reward (HMO) H8225 - 001 Baker, Clay, Duval & Nassau
Ascension Complete Sacred Heart Reward (HMO) H8225 - 002 Escambia and Santa Rosa
Ascension Complete St. Vincent's Secure (HMO) H8225 -003 Baker, Clay, Duval & Nassau
Ascension Complete Sacred Heart Secure (HMO) H8225 - 004 Escambia and Santa Rosa

Illinois - AMITA

Plan Name CMS# County Summary of Benefits
Ascension Complete Illinois Reward (HMO) H7399-001 Cook, DuPage, Kane and Will counties
Ascension Complete Illinois Secure (HMO) H7399-002 Cook, DuPage, Kane and Will counties

Kansas - Via Christi

Plan Name CMS#  County Summary of Benefits
Ascension Complete Via Christi Reward (HMO) H5398-001 Butler, Harvey and Sedgwick counties
Ascension Complete Via Christi Secure (HMO) H5398-002 Butler, Harvey and Sedgwick counties

 

 

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:

Florida - Sacred Heart and St. Vincent's

Plan Name CMS # County Evidence of Coverage (EOC)
Ascension Complete St. Vincent's Reward (HMO) H8225 - 001 Baker, Clay, Duval & Nassau
Ascension Complete Sacred Heart Reward (HMO) H8225 - 002 Escambia and Santa Rosa
Ascension Complete St. Vincent's Secure (HMO) H8225 -003 Baker, Clay, Duval & Nassau
Ascension Complete Sacred Heart Secure (HMO) H8225 - 004 Escambia and Santa Rosa

Illinois - AMITA

Plan Name CMS # County Evidence of Coverage (EOC)
Ascension Complete Illinois Reward (HMO) H7399 - 001 Cook, DuPage, Kane and Will counties
Ascension Complete Illinois Secure (HMO) H7399 - 002 Cook, DuPage, Kane and Will counties

Kansas - Via Christi

Plan Name CMS # County Evidence of Coverage (EOC)
Ascension Complete Via Christi Reward (HMO) H5398 - 001 Butler, Harvey and Sedgwick counties
Ascension Complete Via ChristiSecure (HMO) H5398 - 002 Butler, Harvey and Sedgwick counties

This booklet will tell you about changes to your plan’s costs and benefits for the coming year.

Please select the document for your plan and county:

Florida - Sacred Heart and St. Vincent's

Plan Name CMS # County Annual Notice of Changes (ANOC)
Ascension Complete St. Vincent's Reward (HMO) H8225 - 001 Baker, Clay, Duval & Nassau
Ascension Complete Sacred Heart Reward (HMO) H8225 - 002 Escambia and Santa Rosa
Ascension Complete St. Vincent's Secure (HMO) H8225 -003 Baker, Clay, Duval & Nassau
Ascension Complete Sacred Heart Secure (HMO) H8225 - 004 Escambia and Santa Rosa

Illinois - AMITA

Plan Name CMS# County Annual Notice of Changes (ANOC)
Ascension Complete Illinois Reward (HMO) H7399-001 Cook, DuPage, Kane and Will counties
Ascension Complete Illinois Secure (HMO) H7399-002 Cook, DuPage, Kane and Will counties

Kansas - Via Christi

Plan Name CMS# County Annual Notice of Changes (ANOC) 
Ascension Complete Via Christi Reward (HMO) H5398-001 Butler, Harvey and Sedgwick counties
Ascension Complete Via Christi Secure (HMO) H5398-002 Butler, Harvey and Sedgwick counties

 

 

Your current plan may have an over-the-counter benefit that allows you to purchase over-the-counter (OTC) health and wellness products. This catalog includes a list of over-the-counter items that you can order to be directly mailed to your home. Check the catalog for item limits.

Ordering is easy! Just follow the steps listed on your plan's catalog.