Benefit Documents

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

Standard
Family Assistance
Care Plus

Member Handbook 
BMC HealthNet Plan Mercy Alliance

Standard
Family Assistance
Care Plus

Member Handbook 
BMC HealthNet Plan Signature Alliance 

Standard
Family Assistance
Care Plus

Member Handbook
BMC HealthNet Plan Southcoast Alliance 

Standard
Family Assistance
Care Plus

Member Handbook
BMC HealthNet Plan MCO 

Standard
Family Assistance
Care Plus 

Member Handbook 

Plan Name

 Evidence of        Coverage      

2020 Summary of
Benefits and Coverage

2020 Schedule of    Benefits   

ConnectorCare Type I Evidence of Coverage  Summary of Benefits and Coverage Schedule of Benefits
Esquema De Beneficios 
ConnectorCare Type II Evidence of Coverage Summary of Benefits and Coverage Schedule of Benefits
Esquema De Beneficios 
ConnectoreCare Type III Evidence of Coverage  Summary of Benefits and Coverage Schedule of Benefits
Esquema De Beneficios 
ConnectorCare Zero
& Limited Cost Share Select
Evidence of Coverage Summary of Benefits and Coverage Schedule of Benefits
Esquema De Beneficios 
ConnectorCare Zero
& Limited Cost Share Silver
Evidence of Coverage Summary of Benefits and Coverage Schedule of Benefits
Esquema De Beneficios 
Please see the ConnectorCare Evidence of Coverage and Schedule of Benefits for additional information, including covered and non-covered benefits; any restrictions to services, benefits or the provider network; and a summary of pharmaceutical management procedures. Click the ‘Find a Doctor, Hospital, or Pharmacy’ link at the top right of the page to find out about our providers. Please see Your Privacy for our privacy policies. Please see a summary of utilization management procedures.
Individuals and families who are Qualified Health Plan members, use the first table to find your benefit documents. Members who are on our Employer Choice Plan, please see the second table for your benefit documents.
Plan Name               
Evidence of Coverage  2020 Summary of Benefits 2020 Schedule of Benefits
Platinum

Evidence of Coverage

Planes de salud calificados

Summary of Benefits 

 Schedule of Benefits 

Esquema De Beneficios 
Gold

Evidence of Coverage

Planes de salud calificados

Summary of Benefits

 Schedule of Benefits  

Esquema De Beneficios

Low Gold

Evidence of Coverage

Planes de salud calificados

Summary of Benefits

 Schedule of Benefits 

Esquema De Beneficios

Silver A

Evidence of Coverage

Planes de salud calificados

Summary of Benefits

 Schedule of Benefits 

Esquema De Beneficios

Silver A II

Evidence of Coverage

Planes de salud calificados

Summary of Benefits

 Schedule of Benefits 

Esquema De Beneficios

Silver B

Evidence of Coverage

Planes de salud calificados

Summary of Benefits

 Schedule of Benefits 

Esquema De Beneficios

Bronze

Evidence of Coverage

Planes de salud calificados

Summary of Benefits

 Schedule of Benefits 

Esquema De Beneficios

Please see the Qualified Health Plan Evidence of Coverage and Schedule of Benefits for specific information on each plan, including covered and non-covered benefits; any restrictions to services, benefits or the provider network; and a summary of pharmaceutical management procedures. Click the ‘Find a Doctor, Hospital, or Pharmacy’ link at the top right of the page to find out about our providers. Please see Your Privacy for our privacy policies. Please see a summary of utilization management procedures.
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 ConnectorCare plans.

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. 

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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