Benefit Documents
MassHealth Plans
| Plan Name | Covered Services List |
Member Handbook | Manual del Miembro |
| BMC HealthNet Plan Community Alliance | Manual del Miembro | ||
| BMC HealthNet Plan Mercy Alliance | Standard Family Assistance Care Plus |
Manual del Miembro | |
| BMC HealthNet Plan Signature Alliance | Standard Family Assistance Care Plus |
Manual del Miembro | |
| BMC HealthNet Plan Southcoast Alliance | Standard Family Assistance Care Plus |
Manual del Miembro | |
| BMC HealthNet Plan MCO | Standard Family Assistance Care Plus |
Manual del Miembro |
2021 ConnectorCare Plans
Individuals and families who are 2021 ConnectorCare Plan members, use the below table to find your benefit documents.
| Plan Name | Summary of Benefits | Schedule of Benefits | Evidence of Coverage |
|
ConnectorCare I |
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| ConnectorCare II |
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| ConnectorCare III |
2022 ConnectorCare Plans
Individuals and families who are ConnectorCare Plan members, use the below table to find your benefit documents.
| Plan Name | Summary of Benefits | Schedule of Benefits | Evidence of Coverage |
|
ConnectorCare I |
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| ConnectorCare II |
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| ConnectorCare III |
2021 Qualified Health Plans
Individuals and families who members of a 2021 Qualified Health Plan, use the below table to find your benefit documents and refer to the "Individual" link for your Evidence of Coverage document. Members who are on our Employer Choice Plan, use the below table to find your benefit documents and refer to the "Group" link for your Evidence of Coverage document.
| Plan Name
|
Summary of Benefits | Schedule of Benefits | Evidence of Coverage |
|
Platinum |
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| Gold |
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| Low Gold |
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| Silver A |
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| Silver A II |
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| Silver B |
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Low Silver |
Summary of Benefits | Schedule of Benefits | |
| Bronze |
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AI/AN Limited Cost-Sharing |
Summary of Benefits | ||
| AI/AN Zero Cost-Sharing | Summary of Benefits |
2022 Qualified Health Plans
Individuals and families who are Qualified Health Plan members, use the below table to find your benefit documents and refer to the "Individual" link for your Evidence of Coverage document. Members who are on our Employer Choice Plan, use the below table to find your benefit documents and refer to the "Group" link for your Evidence of Coverage document.
| Plan Name
|
Summary of Benefits | Schedule of Benefits | Evidence of Coverage |
|
Platinum |
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| Gold |
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| Low Gold |
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| Silver A |
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| Silver A II |
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| Silver B |
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Low Silver |
Summary of Benefits | Schedule of Benefits | |
| Bronze |
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|
AI/AN Limited Cost-Sharing |
Summary of Benefits | ||
| AI/AN Zero Cost-Sharing | Summary of Benefits |