Benefit Documents

Use the tabs below to find your plan's benefit documents.
Plan
Plan Type Member Handbook List of Covered and Excluded/Limited Services*

BMC HealthNet Plan Community Alliance

Accountable Care Organization


Member Handbook

Standard
CarePlus
Family Assistance

BMC HealthNet Plan
Mercy Alliance

Accountable Care Organization


Member Handbook

Standard
CarePlus
Family Assistance

BMC HealthNet Plan Signature Alliance

Accountable Care Organization


Member Handbook

Standard
CarePlus
Family Assistance

BMC HealthNet Plan Southcoast Alliance

Accountable Care Organization


Member Handbook

Standard
CarePlus
Family Assistance

BMC HealthNet Plan MassHealth MCO

Managed Care Organization


Member Handbook

Standard (including Special Kids Special Care)
CarePlus
Family Assistance

*These lists are considered part of your Member Handbook. 

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.

Please see the MassHealth Member Handbook and MassHealth Covered Services List 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.

Document Type 2020 Plan Name 2019 Plan Name

Schedule of Benefits

Detailed list of covered services and copays.

ConnectorCare Plan Type I
ConnectorCare Plan Type II
ConnectorCare Plan Type III
ConnectorCare Zero & Limited Cost Share Select
ConnectorCare Zero & Limited Cost Share Silver
ConnectorCare Plan Type I
ConnectorCare Plan Type II
ConnectorCare Plan Type III
ConnectorCare Zero & Limited Cost Share Select
ConnectorCare Zero & Limited Cost Share Silver

Summary of Benefits and Coverage

Helpful documents to use when you are comparing plans.

ConnectorCare Plan Type I
ConnectorCare Plan Type II
ConnectorCare Plan Type III
ConnectorCare Limited Cost and Zero Cost Share Plans
ConnectorCare Plan Type I
ConnectorCare Plan Type II
ConnectorCare Plan Type III
ConnectorCare Limited Cost and Zero Cost Share Plans

Evidence of Coverage

How to use your care including requirements for getting services.

ConnectorCare Evidence of Coverage ConnectorCare Evidence of Coverage

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.
Document Type 2020 Plan Name 20 Plan Name

Schedule of Benefits

Detailed list of covered services and copays.

QHP Bronze
QHP Silver A
QHP Silver A II
QHP Silver B
QHP Gold
QHP Low Gold
QHP Platinum                                            
QHP Bronze
QHP Silver A
QHP Silver A II
QHP Silver B
QHP Gold
QHP Low Gold
QHP Platinum    

Summary of Benefits and Coverage

Helpful documents to use when you are comparing plans.

QHP Bronze
QHP Silver A
QHP Silver A II
QHP Silver B
QHP Gold
QHP Low Gold
QHP Platinum     
QHP Bronze
QHP Silver A
QHP Silver A II
QHP Silver B
QHP Gold
QHP Low Gold
QHP Platinum    

Evidence of Coverage

How to use your care including requirements for getting services.

Qualified Health Plan Evidence of Coverage Qualified Health Plan Evidence of Coverage
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.
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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