Benefit Documents

Use the tabs below to select your plan type and view 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	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
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
Evidence of Coverage How to use your care including requirements for getting services.	ConnectorCare Evidence of Coverage

Please see the current year's 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	Plan Name
Schedule of Benefits Detailed list of covered services and copays.	QHP Bronze 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 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

Please see the current year's 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.

Benefit Documents

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