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

For HMO Members:

For HMO D SNP Members:

For PPO Members:

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:

For HMO D SNP Members:

For PPO Members:

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:

For HMO Members:

• Over-the-Counter Benefits - English (PDF)
• Over-the-Counter Benefits - Spanish (PDF)

• Optional Benefit Individual Enrollment Form - English (PDF)
• Optional Benefit Individual Enrollment Form - Spanish (PDF)

• Optional Supplemental Benefits - Providence (PDF)
• Optional Supplemental Benefits - St. Vincent's  (PDF)

• How to use the Member Portal flyer (PDF)
• How to lower your out-of-pocket costs flyer (PDF)
• A guide to understanding your Explanation of Benefits (EOB) flyer (PDF)
• Member Newsletter

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

** Refer to Addendum to 2023 Medicare Advantage Benefits for additional information**

For HMO Members:

For HMO D SNP Members:

For PPO Members:

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:

** Refer to Addendum to 2023 Medicare Advantage Benefits for additional information**

For HMO D SNP Members:

For PPO Members:

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:

** Refer to Addendum to 2023 Medicare Advantage Benefits for additional information**

For HMO Members:

For HMO D SNP Members:

For PPO Members:

This document is an addendum to the 2023 Evidence of Coverage (EOC), Annual Notice of Change (ANOC) and Summary of Benefits (SB) for the plan(s) listed below.  It describes the member cost sharing protections provided under the Inflation Reduction Act (IRA) for certain Part B drugs.

• Addendum to 2023 Medicare Advantage Benefits (PDF)
  • H4343-001 Ascension Complete St. Vincent's Reward (HMO)
  • H4343-002 Ascension Complete Providence Reward (HMO)
  • H4343-003 Ascension Complete St. Vincent's Secure (HMO)
  • H4343-004 Ascension Complete Providence Secure (HMO)
  • H7556-001 Ascension Complete St. Vincent's Access Plus (PPO)
  • H7556-002 Ascension Complete St. Vincent's Access (PPO)
  • H7556-003 Ascension Complete Providence Access Plus (PPO)
  • H7556-004 Ascension Complete Providence Access (PPO)

For HMO D SNP Members:

For PPO Members:

• Over-the-Counter Catalog - English (PDF)

• Member Newsletter

• Ascension Extra Benefit - English (PDF)
• Ascension Extra Benefit - Spanish (PDF)