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
Ascension Complete Via Christi Secure (HMO) H5398-002 Butler, Harvey and Sedgwick counties

For PPO Members:

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

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
Ascension Complete Via Christi Secure H5398-002 Butler, Harvey and Sedgwick counties

 

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
Ascension Complete Via Christi Access (PPO) H6830-002 Butler, Harvey and Sedgwick counties

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
Ascension Complete Via Christi Secure (HMO) H5398-002 Butler, Harvey and Sedgwick counties

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

If you have any questions please, contact Member Services.