Indiana 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 Reward (HMO) H7925- 001 Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties
  • Summary of Benefits, H7925-001 - English (PDF)
Ascension Complete St. Vincent Secure (HMO) H7925- 002 Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties
  • Summary of Benefits, H7925-002 - English (PDF)

For HMO D SNP Members

Plan Name CMS # County Summary of Benefits
Ascension Complete St. Vincent DSNP (HMO D-SNP) H7925- 003 Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties
  • Summary of Benefits, H7925-003 - English (PDF)

For PPO Members

Plan Name CMS # County Summary of Benefits
Ascension Complete St. Vincent Access (PPO) H1774- 001 Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties
  • Summary of Benefits, H1774-001 - English (PDF)
Ascension Complete St. Vincent Access (PPO) H1774- 002    

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

Plan Name CMS # County Evidence of Coverage (EOC)
Ascension Complete St. Vincent Reward (HMO) H7925- 003 Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties
  • Evidence of Coverage, H7925-003 - English (PDF)

For PPO Members

Plan Name CMS # County Evidence of Coverage (EOC)
Ascension Complete St. Vincent Access (PPO) H1774- 002 Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties
  • Evidence of Coverage, H1774-002 - English (PDF)

If you have questions please, contact Member Services.

If you have questions please, contact Member Services.