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)	H6830-001	Butler, Harvey and Sedgwick counties	Summary of Benefits, H6830-001 (PDF)
Ascension Complete Via Christi Access (PPO)	H6830-002	Butler, Harvey and Sedgwick counties	Summary of Benefits, H6830-002 (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 HMO Members

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Via Christi Reward	H5398-001	Butler, Harvey and Sedgwick counties	Evidence of Coverage, H5398-001 (PDF)
Ascension Complete Via Christi Secure	H5398-002	Butler, Harvey and Sedgwick counties	Evidence of Coverage, H5398-002 (PDF)

For PPO Members:

Plan Name	CMS#	County	Evidence of Coverage (EOC)
Ascension Complete Via Christi Access Plus (PPO)	H6830-001	Butler, Harvey and Sedgwick counties	Evidence of Coverage, H6830-001 (PDF)
Ascension Complete Via Christi Access (PPO)	H6830-002	Butler, Harvey and Sedgwick counties	Evidence of Coverage, H6830-002 (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 Via Christi Reward (HMO)	H5398-001	Butler, Harvey and Sedgwick counties	Annual Notice of Changes H5398-001 (PDF)
Ascension Complete Via Christi Secure (HMO)	H5398-002	Butler, Harvey and Sedgwick counties	Annual Notice of Changes, H5398-002 (PDF)

For PPO Members:

Plan Name	CMS#	County	Annual Notice of Changes (ANOC)
Ascension Complete Via Christi Access Plus (PPO)	H6830-001	Butler, Harvey and Sedgwick counties	Annual Notice of Changes, H6830-001 (PDF)

Optional Supplemental Benefits Flyer (PDF)

Member Newsletter

Plan Name	CMS#	County	Summary of Benefits
Ascension Complete Via Christi Secure (HMO)	H5398-002	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Summary of Benefits, H5398-002 (PDF)
Ascension Complete Via Christi Reward II (HMO)	H5398- 004	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Summary of Benefits, H5398-004 (PDF)

Plan Name	CMS#	County	Summary of Benefits
Ascension Complete Via Christi Access Plus (PPO)	H6830-001	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Summary of Benefits, H6830-001 (PDF)
Ascension Complete Via Christi Access (PPO)	H6830-002	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Summary of Benefits, H6830-002 (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Via Christi Secure (HMO)	H5398-002	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Evidence of Coverage, H5398-002 (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Via Christi Reward II (HMO)	H5398- 004	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Evidence of Coverage, H5398-004 (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS#	County	Evidence of Coverage (EOC)
Ascension Complete Via Christi Access Plus (PPO)	H6830-001	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Evidence of Coverage, H6830-001 (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Via Christi Access (PPO)	H6830-002	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Evidence of Coverage, H6830-002 (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS#	County	Annual Notice of Changes (ANOC)
Ascension Complete Via Christi Secure (HMO)	H5398-002	Butler, Harvey and Sedgwick counties	Annual Notice of Changes, H5398-002 (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete Via Christi Secure (HMO)	H5398-002	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Welcome Kit, H5398-002 (PDF)
Ascension Complete Via Christi Reward II (HMO)	H5398- 004	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Welcome Kit, H5398-004 (PDF)

Plan Name	CMS#	County	Welcome Kit
Ascension Complete Via Christi Access Plus (PPO)	H6830-001	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Welcome Kit, H6830-001 (PDF)
Ascension Complete Via Christi Access (PPO)	H6830-002	Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner	Welcome Kit, H6830-002 (PDF)

If you have any questions please, contact Member Services.

Kansas Plan Materials and Forms

Summary of Benefits

For HMO Members:

For PPO Members:

Evidence of Coverage (EOC)

For PPO Members:

Annual Notice of Changes (ANOC)

Optional Benefit Individual Enrollment Form

Optional Supplemental Benefits Flyer

Over-the-Counter Benefits

Member Newsletter

Kansas Plan Benefit Materials

Summary of Benefits

For HMO Members:

For PPO Members:

Evidence of Coverage (EOC)

For PPO Members:

Annual Notice of Changes (ANOC)

Welcome Kit

For PPO Members:

Over-the-Counter Catalog

Member Newsletter

Extra Benefits