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
- Florida - Sacred Heart and St. Vincent's
- Illinois - AMITA
- Kansas - Via Christi
- Florida - Sacred Heart and St. Vincent's
- Illinois - AMITA
- Kansas - Via Christi