Kansas Plan Materials and Forms


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 Via Christi Reward (HMO) H5398-001 Butler, Harvey and Sedgwick counties
  • Summary of Benefits, H5398-001 (PDF)
Ascension Complete Via Christi Secure (HMO) H5398-002 Butler, Harvey and Sedgwick counties
  • Summary of Benefits, H5398-002 (PDF)

For PPO Members:

Plan Name CMS#  County Summary of Benefits
Ascension Complete Via Christi Access Plus (PPO) H6380-001 Butler, Harvey and Sedgwick counties
  • Summary of Benefits, H6380-001 (PDF)
Ascension Complete Via Christi Access (PPO) H6380-002 Butler, Harvey and Sedgwick counties
  • Summary of Benefits, H6380-002 (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 PPO Members: 

Plan Name CMS# County Evidence of Coverage (EOC)
Ascension Complete Via Christi Access (PPO) H6830-002 Butler, Harvey and Sedgwick counties
  • Evidence of Coverage, H6380-002 (PDF)

Your current plan may have an over-the-counter benefit that allows you to purchase over-the-counter (OTC) health and wellness products. This catalog includes a list of over-the-counter items that you can order to be directly mailed to your home. Check the catalog for item limits.

Ordering is easy! Just follow the steps listed on your plan's catalog.

If you have questions please, contact Member Services.