Illinois 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:

Plan Name	CMS#	County	Summary of Benefits
Ascension Complete AMITA Health Reward (HMO)	H7399-001	Cook, DuPage, Kane, Kankakee, and Will	Summary of Benefits, H7399-001 - English (PDF) Summary of Benefits, H7399-001 - Spanish (PDF)
Ascension Complete AMITA Health Secure (HMO)	H7399-002	Cook, DuPage, Kane, Kankakee, and Will	Summary of Benefits, H7399-002 - English (PDF) Summary of Benefits, H7399-002 - 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:

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete AMITA Health Reward (HMO)	H7399 - 001	Cook, DuPage, Kane, Kankakee, and Will	Evidence of Coverage, H7399-001 - English (PDF) Evidence of Coverage, H7399-001 - Spanish (PDF)
Ascension Complete AMITA Health Secure (HMO)	H7399 - 002	Cook, DuPage, Kane, Kankakee, and Will	Evidence of Coverage, H7399-002 - English (PDF) Evidence of Coverage, H7399-002 - Spanish (PDF)

If you were enrolled in Ascension Complete last year, 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
Ascension Complete AMITA Health Reward (HMO)	H7399-001	Cook, DuPage, Kane, Kankakee, and Will	Annual Notice of Changes, H7399-001 - English (PDF) Annual Notice of Changes, H7399-001 - Spanish (PDF)
Ascension Complete AMITA Health Secure (HMO)	H7399-002	Cook, DuPage, Kane, Kankakee, and Will	Annual Notice of Changes, H7399-002 - English (PDF) Annual Notice of Changes, H7399-002 - Spanish (PDF)

Member Newsletter

Plan Name	CMS#	County	Summary of Benefits
Ascension Complete AMITA Health Reward	H7399-001	Cook, DuPage, Kane and Will counties	Summary of Benefits, H7399-001 - English (PDF) Summary of Benefits, H7399-001 - Spanish (PDF)
Ascension Complete AMITA Health Secure	H7399-002	Cook, DuPage, Kane and Will counties	Summary of Benefits, H7399-002 - English (PDF) Summary of Benefits, H7399-002 - Spanish (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete AMITA Health Reward	H7399 - 001	Cook, DuPage, Kane and Will counties	Evidence of Coverage, H7399-001 - English (PDF) Evidence of Coverage, H7399-001 - Spanish (PDF)
Ascension Complete AMITA Health Secure	H7399 - 002	Cook, DuPage, Kane and Will counties	Evidence of Coverage, H7399-002 - English (PDF) Evidence of Coverage, H7399-002 - Spanish (PDF)

Plan Name	CMS#	County	Annual Notice of Changes (ANOC)
Ascension Complete AMITA Health Reward	H7399-001	Cook, DuPage, Kane and Will counties	Annual Notice of Changes, H7399-001 - English (PDF) Annual Notice of Changes, H7399-001 - Spanish (PDF)
Ascension Complete AMITA Health Secure	H7399-002	Cook, DuPage, Kane and Will counties	Annual Notice of Changes, H7399-002 - English (PDF) Annual Notice of Changes, H7399-002 - Spanish (PDF)

If you have questions please, contact Member Services.

Illinois Plan Benefit Materials

Summary of Benefits

Evidence of Coverage (EOC)

Annual Notice of Changes (ANOC)

Optional Benefit Individual Enrollment Form

Optional Supplemental Benefits Flyer

Over-the-Counter Benefits

Member Newsletter

Illinois Plan Benefit Materials

Summary of Benefits

Evidence of Coverage (EOC)

Annual Notice of Changes (ANOC)

Over-the-Counter Benefits

Optional Supplemental Benefits Flyer

Brochures, Flyers and Inserts