Benefit Documents

Use the tabs below to find your plan's benefit documents.

MassHealth Plans 

Plan Name Covered Services List
Member Handbook  Manual del Miembro
BMC HealthNet Plan Community Alliance

Standard
Family Assistance
Care Plus

 Member Handbook

 Manual del Miembro
BMC HealthNet Plan Mercy Alliance Standard
Family Assistance
Care Plus

Member Handbook

 Manual del Miembro
BMC HealthNet Plan Signature Alliance  Standard
Family Assistance
Care Plus

Member Handbook

 Manual del Miembro
BMC HealthNet Plan Southcoast Alliance  Standard
Family Assistance
Care Plus

Member Handbook

 Manual del Miembro
BMC HealthNet Plan MCO  Standard
Family Assistance
Care Plus

Member Handbook

 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

Summary of Benefits

Schedule of Benefits

Evidence of Coverage

ConnectorCare II

Summary of Benefits

Schedule of Benefits

Evidence of Coverage

ConnectorCare III

Summary of Benefits

 Schedule of Benefits

Evidence of Coverage

 

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

Summary of Benefits

Schedule of Benefits

Evidence of Coverage

ConnectorCare II

Summary of Benefits

Schedule of Benefits

Evidence of Coverage

ConnectorCare III

Summary of Benefits

 Schedule of Benefits

Evidence of Coverage

 

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

Summary of Benefits 

 Schedule of Benefits 

Individual

Group

Gold

Summary of Benefits

 Schedule of Benefits  

Individual

Group

Low Gold

Summary of Benefits

 Schedule of Benefits 

 Individual

Group

Silver A

Summary of Benefits

 Schedule of Benefits 

Individual

Silver A II

Summary of Benefits

 Schedule of Benefits 

Individual

Group

Silver B

Summary of Benefits

 Schedule of Benefits 

Individual

Low Silver

Summary of Benefits Schedule of Benefits

Group

 
Bronze

Summary of Benefits

 Schedule of Benefits 

Individual

Group

 AI/AN Limited Cost-Sharing

Summary of Benefits 

Select Network

Silver Network

Individual

 AI/AN Zero Cost-Sharing Summary of Benefits 

Select Network

Silver Network

Individual

 

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

Summary of Benefits 

 Schedule of Benefits 

Individual

Group

Gold

Summary of Benefits

 Schedule of Benefits  

Individual

Group

Low Gold

Summary of Benefits

 Schedule of Benefits 

 Individual

Group

Silver A

Summary of Benefits

 Schedule of Benefits 

Individual

Silver A II

Summary of Benefits

 Schedule of Benefits 

Individual

Group

Silver B

Summary of Benefits

 Schedule of Benefits 

Individual

Low Silver

Summary of Benefits Schedule of Benefits

Group

 
Bronze

Summary of Benefits

 Schedule of Benefits 

Individual

Group

 AI/AN Limited Cost-Sharing

Summary of Benefits 

Select Network

Silver Network

Individual

 AI/AN Zero Cost-Sharing Summary of Benefits 

Select Network

Silver Network

Individual

 

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.

We're always working to improve the quality of our services for members. If you're interested in learning more, you can read our Quality Improvement Work Plan Evaluation.

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