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 Reward (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 Plus (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	Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties	Summary of Benefits, H1774-002 - English (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 Reward (HMO)	H7925- 001	Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties	Evidence of Coverage, 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	Evidence of Coverage, H7925-002 - English (PDF)

For HMO D SNP Members

Plan Name	CMS #	County	Evidence of Coverage (EOC)
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	Evidence of Coverage, H7925-003 - English (PDF)

For PPO Members

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

For HMO Members

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete St. Vincent Reward (HMO)	H7925- 001	Boone, Gibson, Hamilton, Hancock, Hendricks, Howard, Madison, Montgomery, Posey, Putnam, Shelby, Vanderburgh and Warrick counties	Annual Notice of Changes, 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	Annual Notice of Changes, H7925-002 - English (PDF)

For PPO Members

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

Optional Supplemental Benefits Flyer (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete St. Vincent Reward (HMO)	H7925- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Summary of Benefits, H7925-001 - English (PDF)
Ascension Complete St. Vincent Secure (HMO)	H7925- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Summary of Benefits, H7925-002 - English (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete St. Vincent Reward (HMO D-SNP)	H7925- 003	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Summary of Benefits, H7925-003 - English (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete St. Vincent Access Plus (PPO)	H1774- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Summary of Benefits, H1774-001 - English (PDF)
Ascension Complete St. Vincent Access (PPO)	H1774- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Summary of Benefits, H1774-002 - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete St. Vincent Reward (HMO)	H7925- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Evidence of Coverage, H7925-001 - English (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Ascension Complete St. Vincent Secure (HMO)	H7925- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Evidence of Coverage, H7925-002 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete St. Vincent DSNP (HMO D-SNP)	H7925- 003	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Evidence of Coverage, H7925-003 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete St. Vincent Access Plus (PPO)	H1774- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Evidence of Coverage, H1774-001 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete St. Vincent Access (PPO)	H1774- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Evidence of Coverage, H1774-002 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete St. Vincent Reward (HMO)	H7925- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Annual Notice of Changes, H7925-001 - English (PDF)
Ascension Complete St. Vincent Secure (HMO)	H7925- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Annual Notice of Changes, H7925-002 - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete St. Vincent DSNP (HMO D-SNP)	H7925- 003	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Annual Notice of Changes, H7925-003 - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes
Ascension Complete St. Vincent Access Plus (PPO)	H1774- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Annual Notice of Changes, H1774-001 - English (PDF)
Ascension Complete St. Vincent Access (PPO)	H1774- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, WarrickBoone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Annual Notice of Changes, H1774-002 - English (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete St. Vincent Reward (HMO)	H7925- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Welcome Kit, H7925-001 - English (PDF)
Ascension Complete St. Vincent Secure (HMO)	H7925- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Welcome Kit, H7925-002 - English (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete St. Vincent DSNP (HMO D-SNP)	H7925- 003	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Welcome Kit, H7925-003 - English (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete St. Vincent Access Plus (PPO)	H1774- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Welcome Kit, H1774-001 - English (PDF)
Ascension Complete St. Vincent Access (PPO)	H1774- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Welcome Kit, H1774-002 - English (PDF)

If you have questions please, contact Member Services.

Indiana Plan Benefit Materials

Summary of Benefits

Evidence of Coverage (EOC)

Annual Notice of Changes (ANOC)

Over-the-Counter Benefits

Optional Supplemental Benefits Flyer

Optional Benefit Individual Enrollment

Member Newsletter

Indiana Plan Benefit Materials

Summary of Benefits

Evidence of Coverage (EOC)

Annual Notice of Changes (ANOC)

Addendum To 2023 Medicare Advantage Benefits

Welcome Kit

Over-the-Counter Catalog

Member Newsletter

Extra Benefits