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)
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)

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)
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)

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)
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)

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 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	Annual Notice of Changes, H2853-001 - English (PDF)
Ascension Complete Saint Thomas Secure (HMO)	H2853- 002	Cannon, Cheatham, Davidson, Robertson, Rutherford, Smith, Sumner, Trousdale. Williamson and Wilson counties	Annual Notice of Changes, H2853-002 - English (PDF)

Optional Supplemental Benefits Flyer (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Saint Thomas Reward (HMO)	H2853- 001	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Summary of Benefits, H2853-001 - English (PDF)
Ascension Complete Saint Thomas Secure (HMO)	H2853- 002	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Summary of Benefits, H2853-002 - English (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Saint Thomas Access Plus (PPO)	H8121-001	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Summary of Benefits, H8121-001 - English (PDF)
Ascension Complete Saint Thomas Access (PPO)	H8121-002	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Summary of Benefits, H8121-002 - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Saint Thomas Reward (HMO)	H2853- 001	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Evidence of Coverage, H2853-001 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Saint Thomas Secure (HMO)	H2853- 002	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Evidence of Coverage, H2853-002 - English (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Saint Thomas Access Plus (PPO)	H8121-001	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Evidence of Coverage, H8121-001 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Saint Thomas Access (PPO)	H8121-002	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Evidence of Coverage, H8121-002 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete Saint Thomas Reward (HMO)	H2853- 001	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Annual Notice of Changes, H2853-001 - English (PDF)
Ascension Complete Saint Thomas Secure (HMO)	H2853- 002	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Annual Notice of Changes, H2853-002 - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete Saint Thomas Access Plus (PPO)	H8121-001	Cannon, Cheatham, Davidson, DeKalb, Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Annual Notice of Changes, H8121-001 - English (PDF)
Ascension Complete Saint Thomas Access (PPO)	H8121-002	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Annual Notice of Changes, H8121-002 - English (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete Saint Thomas Reward (HMO)	H2853- 001	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Welcome Kit, H2853-001 - English (PDF)
Ascension Complete Saint Thomas Secure (HMO)	H2853- 002	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Welcome Kit, H2853-002 - English (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete Saint Thomas Access Plus (PPO)	H8121-001	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Welcome Kit, H8121-001 - English (PDF)
Ascension Complete Saint Thomas Access (PPO)	H8121-002	Cannon, Cheatham, Davidson, DeKalb, Hickman, Humphreys, Robertson, Rutherford, Smith, Sumner, Trousdale, Van Buren, Warren, White, Williamson, Wilson	Welcome Kit, H8121-002 - English (PDF)

If you have questions please, contact Member Services.

Tennessee Plan Benefit Materials

Summary of Benefits

For HMO Members:

For PPO Members:

Evidence of Coverage (EOC)

For HMO Members:

For PPO Members:

Annual Notice of Changes (ANOC)

Over-the-Counter Benefits

Optional Supplemental Benefits

Optional Benefit Individual Enrollment

Member Newsletter

Tennessee Plan Benefit Materials

Summary of Benefits

For HMO Members:

Evidence of Coverage (EOC)

For HMO Members:

Annual Notice of Changes (ANOC)

For HMO Members:

Welcome Kit

For HMO Members:

Over-the-Counter Catalog

Extra Benefits