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
  • Summary of Benefits, H2853-001 - English (PDF)- coming soon
Ascension Complete Saint Thomas Secure (HMO) H2853- 002 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale. Williamson and Wilson counties
  • Summary of Benefits, H2853-002 - English (PDF) coming soon

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
  • Summary of Benefits, H8121-001 - English (PDF)-coming soon

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

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 Saint Thomas Reward (HMO) H2853- 001 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale. Williamson and Wilson counties
  • Evidence of Coverage, H2853-001 - English (PDF) - coming soon
Ascension Complete Saint Thomas Secure (HMO) H2853- 002 Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale. Williamson and Wilson counties
  • Evidence of Coverage, H2853-002 - English (PDF) - coming soon

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) - coming soon
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) - coming soon

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 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

If you have questions please, contact Member Services.