Benefit Documents

Use the tabs below to find your plan's benefit documents.
Plan Name Covered Services List
Member Handbook  Manual del Miembro
BMC HealthNet Plan Community Alliance

Standard
Family Assistance
Care Plus

 Member Handbook

 Manual del Miembro
BMC HealthNet Plan Mercy Alliance Standard
Family Assistance
Care Plus

Member Handbook

 Manual del Miembro
BMC HealthNet Plan Signature Alliance  Standard
Family Assistance
Care Plus

Member Handbook

 Manual del Miembro
BMC HealthNet Plan Southcoast Alliance  Standard
Family Assistance
Care Plus

Member Handbook

 Manual del Miembro
BMC HealthNet Plan MCO  Standard
Family Assistance
Care Plus

Member Handbook

 Manual del Miembro

If you already know that plan type you are searching for, you can type in the the name of the plan in the search bar below. Listed here you will find the 'Summary of Benefits and Coverage', 'Schedule of Benefits', and 'Evidence of Coverage' for all 2021 Qualified Health Plans.

If you are looking for documents as part of an Employer Choice Plan, you will want to reference the 'Group' categories. 

Type Title Category
2021 - Group Plans - Evidence of Coverage
Group Only
2021 - Group Plans - Evidence of Coverage (Spanish)
Group Only
2021 - QHP Low silver - Schedule of Benefits
Group Only
2021 - QHP Low Silver - Summary of Benefits and Coverage
Group Only
2021 - QHP Bronze - Summary of Benefits and Coverage
Individual and Group
2021 - QHP Bronze - Schedule of Benefits
Individual and Group
2021 - QHP Gold - Schedule of Benefits
Individual and Group
2021 - QHP Low Gold - Schedule of Benefits
Individual and Group
2021 - QHP Platinum - Schedule of Benefits
Individual and Group
2021 - QHP Silver A - Schedule of Benefits
Individual and Group
2021 - QHP Silver A II - Schedule of Benefits
Individual and Group
2021 - QHP Silver B - Schedule of Benefits
Individual and Group
2021 - QHP Low Gold - Summary of Benefits and Coverage
Individual and Group
2021 - QHP Gold - Summary of Benefits and Coverage
Individual and Group
2021 - QHP Silver B - Summary of Benefits and Coverage
Individual and Group
2021 - QHP Platinum - Summary of Benefits and Coverage
Individual and Group
2021 - QHP Silver A - Summary of Benefits and Coverage
Individual and Group
2021 - QHP Silver A II - Summary of Benefits and Coverage
Individual and Group
2021 - Individual Plans - Evidence of Coverage
Individual Only
2021 - Individual Plans - Evidence of Coverage (Spanish)
Individual Only
2021 - AI/AN Zero and Limited Cost Sharing Silver - Summary of Benefits and Coverage
Individual Only
2021 - AI/AN Zero and Limited Cost Sharing Select - Summary of Benefits and Coverage
Individual Only
2021 - AI/AN Zero and Limited Cost Sharing Select - Schedule of Benefits
Individual Only
2021 - AI/AN Zero and Limited Cost Sharing Silver - Schedule of Benefits
Individual Only
To request a printed copy of the Member Handbook, please contact Member Services.

Some procedures or services require prior authorization, or prior approval, from us. You or your doctor may confirm if the service requires a prior authorization by checking our Medical Procedure Code Lookup Tool or our Supplies and Services Code Lookup Tool.

We're always working to improve the quality of our services for members. If you're interested in learning more, you can read our Quality Improvement Work Plan Evaluation.

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