Benefit Documents
Use the tabs below to select your plan type and view your plan's benefit documents.
| 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 |
|
Plan Name |
Evidence of Coverage |
2020 Summary of |
2020 Schedule of Benefits |
| ConnectorCare Type I | Evidence of Coverage | Summary of Benefits and Coverage | Schedule of Benefits Esquema De Beneficios |
| ConnectorCare Type II | Evidence of Coverage | Summary of Benefits and Coverage | Schedule of Benefits Esquema De Beneficios |
| ConnectoreCare Type III | Evidence of Coverage | Summary of Benefits and Coverage | Schedule of Benefits Esquema De Beneficios |
| ConnectorCare Zero & Limited Cost Share Select |
Evidence of Coverage | Summary of Benefits and Coverage | Schedule of Benefits Esquema De Beneficios |
| ConnectorCare Zero & Limited Cost Share Silver |
Evidence of Coverage | Summary of Benefits and Coverage | Schedule of Benefits Esquema De Beneficios |
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.
Individuals and families who are Qualified Health Plan members, use the first table to find your benefit documents. Members who are on our Employer Choice Plan, please see the second table for your benefit documents.
| Plan Name
|
Evidence of Coverage | 2020 Summary of Benefits | 2020 Schedule of Benefits |
| Platinum | Esquema De Beneficios | ||
| Gold | |||
| Low Gold | |||
| Silver A | |||
| Silver A II | |||
| Silver B | |||
| Bronze |
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.
If you already know that plan type you are searching for, you can type in the the name of the plan in the search bar below. Listed here you will find the 'Summary of Benefits and Coverage', 'Schedule of Benefits', and 'Evidence of Coverage' for all 2021 ConnectorCare plans.
If you already know that plan type you are searching for, you can type in the the name of the plan in the search bar below. Listed here you will find the 'Summary of Benefits and Coverage', 'Schedule of Benefits', and 'Evidence of Coverage' for all 2021 Qualified Health Plans.
If you are looking for documents as part of an Employer Choice Plan, you will want to reference the 'Group' categories.