Tennessee 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 Saint Thomas Reward (HMO) H2853- 001 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale. Williamson and Wilson counties
Ascension Complete Saint Thomas Secure (HMO) H2853- 002 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale. Williamson and Wilson counties

For PPO Members: 

Plan Name CMS # County Summary of Benefits
Ascension Complete Saint Thomas Access Plus (PPO) H8121- 001 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale, Williamson, Wilson
Ascension Complete Saint Thomas Access (PPO) H8121- 002 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale, Williamson, Wilson

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 Saint Thomas Access Plus (PPO) H8121- 001 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale, Williamson, Wilson
  • Evidence of Coverage, H8121-001 - English (PDF)

Ascension Complete Saint Thomas Access (PPO) H8121- 002 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale, Williamson, Wilson
  • Evidence of Coverage, H8121-002 - English (PDF)

If you have questions please, contact Member Services.

If you have questions please, contact Member Services.