Michigan 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 Michigan Reward (HMO)	H0482- 001	Genesee, Iosco, Kalamazoo, and Saginaw	Summary of Benefits, H0482-001 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 002	Genesee, Iosco, Kalamazoo, and Saginaw	Summary of Benefits, H0482-002 - English (PDF)
Ascension Complete Michigan Reward (HMO)	H0482- 003	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H0482-003 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 004	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H0482-004 - English (PDF)

For HMO D SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Michigan DSNP (HMO D-SNP)	H0482- 005	Genesee, Iosco, Kalamazoo, and Saginaw	Summary of Benefits, H0482-005 - English (PDF)

For PPO Members:

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Michigan Access Plus (PPO)	H7512- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H7512-001 - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H7512-002 - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 003	Genesee, Iosco, Kalamazoo, Saginaw	Summary of Benefits, H7512-003 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 004	Genesee, Iosco, Kalamazoo, Saginaw	Summary of Benefits, H7512-004 - 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 Michigan Reward (HMO)	H0482- 001	Genesee, Iosco, Kalamazoo, and Saginaw	Evidence of Coverage, H0482-001 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 002	Genesee, Iosco, Kalamazoo, and Saginaw	Evidence of Coverage, H0482-002 - English (PDF)
Ascension Complete Michigan Reward (HMO)	H0482- 003	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H0482-003 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 004	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H0482-004 - English (PDF)

For HMO D SNP Members:

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Michigan DSNP (HMO D-SNP)	H0482- 005	Genesee, Iosco, Kalamazoo, Saginaw	Evidence of Coverage, H0482-005 - English (PDF)

For PPO Members:

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Michigan Access Plus (PPO)	H7512- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H7512-001 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H7512-002 - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 003	Genesee, Iosco, Kalamazoo, Saginaw	Evidence of Coverage, H7512-003 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 004	Genesee, Iosco, Kalamazoo, Saginaw	Evidence of Coverage, H7512-004 - 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 Michigan Reward (HMO)	H0482- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H0482-001 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H0482-002 - English (PDF)

Ascension Complete Michigan Reward (HMO)

Genesee, Kalamazoo, and Saginaw counties

Optional Supplemental Benefits Flyer - H0482-001 - English (PDF)

Lapeer, Livingston, Macomb, Oakland, St. Clair, and Wayne counties

Optional Supplemental Benefits Flyer - H0482-003 - English (PDF)

Optional Benefit Individual Enrollment Form (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Michigan Reward (HMO)	H0482- 001	Genesee, Iosco, KArenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Summary of Benefits, H0482-001 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 002	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Summary of Benefits, H0482-002 - English (PDF)
Ascension Complete Michigan Reward (HMO)	H0482- 003	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H0482-003 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 004	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H0482-004 - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Michigan Reward (HMO)	H0482- 001	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Evidence of Coverage, H0482-001 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 002	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Evidence of Coverage, H0482-002 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Reward (HMO)	H0482- 003	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H0482-003 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 004	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H0482-004 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Michigan DSNP (HMO D-SNP)	H0482- 005	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Evidence of Coverage, H0482-005 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan DSNP (HMO D-SNP)	H0482- 006	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H0482-006 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Michigan Access Plus (PPO)	H7512- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H7512-001 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H7512-002 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Evidence of Coverage, H7512-003 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 004	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Evidence of Coverage, H7512-004 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete Michigan Reward (HMO)	H0482- 001	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H0482-001 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 002	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H0482-002 - English (PDF)
Ascension Complete Michigan Reward (HMO)	H0482- 003	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H0482-003 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 004	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H0482-004 - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete Michigan DSNP (HMO D-SNP)	H0482- 005	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H0482-005 - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete Michigan Access Plus (PPO)	H7512- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H7512-001 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H7512-002 - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H7512-003 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 004	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H7512-004 - English (PDF)

If you have any questions please, contact Member Services.

Michigan Plan Benefit Materials

Summary of Benefits

For HMO Members:

For HMO D SNP Members:

For PPO Members:

Evidence of Coverage (EOC)

For HMO Members:

For HMO D SNP Members:

For PPO Members:

Annual Notice of Changes (ANOC)

Over-the-Counter Benefits

Optional Supplemental Benefits Flyer

Ascension Complete Michigan Reward (HMO)

Genesee, Kalamazoo, and Saginaw counties

Lapeer, Livingston, Macomb, Oakland, St. Clair, and Wayne counties

Member Newsletter

Optional Benefit Individual Enrollment Form

Michigan Plan Benefit Materials

Summary of Benefits

For HMO Members:

For HMO D SNP Members:

For PPO Members:

Evidence of Coverage (EOC)

For HMO Members:

For HMO D SNP Members:

For PPO Members:

Annual Notice of Changes (ANOC)

Over-the-Counter Catalog

Member Newsletter

Extra Benefits