Florida Plan Benefit Materials

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:

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete St. Vincent's Reward (HMO)	H8225 - 001	Baker, Clay, Duval, and Nassau	Summary of Benefits, H8225-001 - English (PDF) Summary of Benefits, H8225-001 - Spanish (PDF)
Ascension Complete Sacred Heart Reward (HMO)	H8225 - 002	Escambia, Santa Rosa, and Walton	Summary of Benefits, H8225-002 - English (PDF) Summary of Benefits, H8225-002 - Spanish (PDF)
Ascension Complete St. Vincent's Secure (HMO)	H8225 -003	Baker, Clay, Duval, and Nassau	Summary of Benefits, H8225-003 - English (PDF) Summary of Benefits, H8225- 003 - Spanish (PDF)
Ascension Complete Sacred Heart Secure (HMO)	H8225 - 004	Escambia, Santa Rosa, and Walton	Summary of Benefits, H8225-004 - English (PDF) Summary of Benefits, H8225-004 - Spanish (PDF)
Ascension Complete St. Vincent's Access POS	H8225-007	Baker, Clay, Duval, and Nassau	Summary of Benefits, H8225-007 - English (PDF) Summary of Benefits, H8225-007 - Spanish (PDF)
Ascension Complete Sacred Heart Access POS	H8225-008	Escambia, Santa Rosa, and Walton	Summary of Benefits, H8225-008 - English (PDF) Summary of Benefits, H8225-008 - Spanish (PDF)

For HMO D SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete St. Vincent's DSNP	H8225 - 005	Baker, Clay, Duval, and Nassau	Summary of Benefits, H8225-005 - English (PDF) Summary of Benefits, H8225-005 - Spanish (PDF)
Ascension Complete Sacred Heart DSNP	H8225 - 006	Escambia, Santa Rosa, and Walton	Summary of Benefits, H8225-006 - English (PDF) Summary of Benefits, H8225-006 - Spanish (PDF)

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 Members:

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete St. Vincent's Reward (Jacksonville)	H8225 - 001	Baker, Clay, Duval, and Nassau	Evidence of Coverage, H8225-001 - English (PDF) Evidence of Coverage, H8225-001 - Spanish (PDF)
Ascension Complete Sacred Heart Reward (Pensacola)	H8225 - 002	Escambia, Santa Rosa, and Walton	Evidence of Coverage, H8225-002 - English (PDF) Evidence of Coverage, H8225-002 - Spanish (PDF)
Ascension Complete St. Vincent's Secure (Jacksonville)	H8225 - 003	Baker, Clay, Duval, and Nassau	Evidence of Coverage, H8225-003 - English (PDF) Evidence of Coverage, H8225-003 - Spanish (PDF)
Ascension Complete Sacred Heart Secure (Pensacola)	H8225 - 004	Escambia, Santa Rosa, and Walton	Evidence of Coverage, H8225-004 - English (PDF) Evidence of Coverage, H8225-004 - Spanish (PDF)
Ascension Complete St. Vincent's Access POS (HMO POS)	H8225 - 007	Baker, Clay, Duval, and Nassau	Evidence of Coverage, H8225-007 - English (PDF) Evidence of Coverage, H8225-007 - Spanish (PDF)
Ascension Complete Sacred Heart Access POS	H8225 - 008	Escambia, Santa Rosa, and Walton	Evidence of Coverage, H8225-008 - English (PDF) Evidence of Coverage, H8225-008 - Spanish (PDF)

For HMO D SNP Members:

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete St. Vincent's DSNP (HMO D-SNP)	H8225 - 005	Baker, Clay, Duval, and Nassau	Evidence of Coverage, H8225-005 - English (PDF) Evidence of Coverage, H8225-005 - Spanish (PDF)
Ascension Complete Sacred Heart DSNP (HMO D-SNP)	H8225 - 006	Escambia, Santa Rosa, and Walton	Evidence of Coverage, H8225-006 - English (PDF) Evidence of Coverage, H8225-006 - Spanish (PDF)

Plan Name

CMS #

County

Evidence of Coverage (EOC)

Ascension Complete St. Vincent's DSNP (HMO D-SNP)

H8225 - 005

Baker, Clay, Duval, and Nassau

Evidence of Coverage, H8225-005 - English (PDF)

Evidence of Coverage, H8225-005 - Spanish (PDF)

Ascension Complete Sacred Heart DSNP (HMO D-SNP)

H8225 - 006

Escambia, Santa Rosa, and Walton

Evidence of Coverage, H8225-006 - English (PDF)

Evidence of Coverage, H8225-006 - Spanish (PDF)

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:

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

Member Newsletter

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Florida Reward (HMO)	H8225 - 001	Baker, Clay, Duval, Escambia, Nassau, Santa Rosa, St. Johns, Walton	Summary of Benefits, H8225-001 - English (PDF)
Ascension Complete St. Vincent's Secure (HMO)	H8225 -003	Baker, Clay, Duval, Nassau, St. Johns	Summary of Benefits, H8225-003 - English (PDF)
Ascension Complete Sacred Heart Secure (HMO)	H8225 - 004	Escambia, Santa Rosa, Walton	Summary of Benefits, H8225-004 - English (PDF)
Ascension Complete St. Vincent's Access POS	H8225-007	Baker, Clay, Duval, Nassau, St. Johns	Summary of Benefits, H8225-007 - English (PDF)
Ascension Complete Sacred Heart Access POS	H8225-008	Escambia, Santa Rosa, Walton	Summary of Benefits, H8225-008 - English (PDF)
Ascension Complete Florida Reward II (HMO)	H8225-009	Baker, Clay, Duval, Escambia, Nassau, Santa Rosa, St. Johns, Walton	Summary of Benefits, H8225-009 - English (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete St. Vincent's DSNP	H8225 - 005	Baker, Clay, Duval, Nassau, St. Johns	Summary of Benefits, H8225-005 - English (PDF)
Ascension Complete Sacred Heart DSNP	H8225 - 006	Escambia, Santa Rosa, Walton	Summary of Benefits, H8225-006 - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Florida Reward (HMO)	H8225 - 001	Baker, Clay, Duval, Escambia, Nassau, Santa Rosa, St. Johns, Walton	Evidence of Coverage, H8225-001 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete St. Vincent's Secure (HMO)	H8225 - 003	Baker, Clay, Duval, and Nassau	Evidence of Coverage, H8225-003 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Sacred Heart Secure (HMO)	H8225 - 004	Escambia, Santa Rosa, Walton	Evidence of Coverage, H8225-004 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete St. Vincent's Access POS (HMO POS)	H8225 - 007	Baker, Clay, Duval, Nassau, St. Johns	Evidence of Coverage, H8225-007 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Sacred Heart Access POS (HMO-POS)	H8225 - 008	Escambia, Santa Rosa, Walton	Evidence of Coverage, H8225-008 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Florida Reward II (HMO)	H8225-009	Baker, Clay, Duval, Escambia, Nassau, Santa Rosa, St. Johns, Walton	Evidence of Coverage, H8225-009 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete St. Vincent's DSNP (HMO D-SNP)	H8225 - 005	Baker, Clay, Duval, Nassau, St. Johns	Evidence of Coverage, H8225-005 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Sacred Heart DSNP (HMO D-SNP)	H8225 - 006	Escambia, Santa Rosa, Walton	Evidence of Coverage, H8225-006 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete St. Vincent's Reward	H8225 - 001	Baker, Clay, Duval, Escambia, Nassau, Santa Rosa, St. Johns, Walton	Annual Notice of Changes, H8225-002 & H8225-001 - English (PDF)
Ascension Complete Florida Reward (HMO) & Ascension Complete Sacred Heart Reward (HMO)	H8225 - 002 and H8225-001	Baker, Clay, Duval, Escambia, Nassau, Santa Rosa, St. Johns, Walton	Annual Notice of Changes, H8225-002 & H8225-001 - English (PDF)
Ascension Complete St. Vincent's Secure (HMO)	H8225 -003	Baker, Clay, Duval, Nassau, St. Johns	Annual Notice of Changes, H8225-003 - English (PDF)
Ascension Complete Sacred Heart Secure (HMO)	H8225 - 004	Escambia, Santa Rosa, Walton	Annual Notice of Changes, H8225-004 - English (PDF)
Ascension Complete St. Vincent's Access POS (HMO-POS)	H8225 - 007	Baker, Clay, Duval, Nassau, St. Johns	Annual Notice of Changes, H8225-007 - English (PDF)
Ascension Complete Sacred Heart Access POS (HMO-POS)	H8225 - 008	Escambia, Santa Rosa, Walton	Annual Notice of Changes, H8225-008 - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete St. Vincent's DSNP (HMO D-SNP)	H8225 - 005	Baker, Clay, Duval, Nassau, St. Johns	Annual Notice of Changes, H8225-005 - English (PDF)
Ascension Complete Sacred Heart DSNP (HMO D-SNP)	H8225 -006	Escambia, Santa Rosa, Walton	Annual Notice of Changes, H8225-006 - English (PDF)

If you have any questions please, contact Member Services.

Florida Plan Benefit Materials

Summary of Benefits

For HMO Members:

For HMO D SNP Members:

Evidence of Coverage (EOC)

For HMO Members:

For HMO D SNP Members:

Annual Notice of Changes (ANOC)

Optional Benefit Individual Enrollment Form

Optional Supplemental Benefits Flyer

Over-the-Counter Benefits

Member Newsletter

Florida Plan Benefit Materials

Summary of Benefits

For HMO Members:

For HMO D SNP Members:

Evidence of Coverage (EOC)

For HMO Members:

For HMO D SNP Members:

Annual Notice of Changes (ANOC)

Optional Benefit Individual Enrollment Form

Optional Supplemental Benefits Flyer

Over-the-Counter Catalog

Extra Benefits