Benefit Documents
| Plan |
Plan Type | Member Handbook | List of Covered and
Excluded/Limited Services* |
|---|---|---|---|
|
BMC HealthNet Plan Community Alliance |
Accountable Care Organization |
||
|
BMC HealthNet Plan |
Accountable Care Organization |
||
|
BMC HealthNet Plan Signature Alliance |
Accountable Care Organization |
||
|
BMC HealthNet Plan Southcoast Alliance |
Accountable Care Organization |
||
|
BMC HealthNet Plan MassHealth MCO |
Managed Care Organization |
Standard (including Special Kids Special Care) |
*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 |
| Document Type | 2020 Plan Name | 2019 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 |