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.

Document Type	2018	2019
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 Share Plan ConnectorCare No Cost Share Plan	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	2018	2019
Schedule of Benefits Detailed list of covered services and copays.	QHP Bronze QHP Silver A QHP Silver A II QHP Silver B QHP Silver B II QHP Gold QHP Platinum	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 QHP Silver A II QHP Silver B QHP Silver B II QHP Gold QHP Platinum	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	Qualified Health Plan Evidence of Coverage

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