2025 Plan Documents
Documents and Forms Library
Benefits Documents
Basic HMO Plan
Mass Advantage Basic (HMO) Summary of Benefits
Mass Advantage Basic (HMO) Evidence of Coverage
Plus HMO Plan
Mass Advantage Plus (HMO) Summary of Benefits
Mass Advantage Plus (HMO) Evidence of Coverage
Premiere PPO Plan
Mass Advantage Premiere (PPO) Summary of Benefits
Mass Advantage Premiere (PPO) Evidence of Coverage
Extra PPO Plan
Mass Advantage Extra (PPO) Summary of Benefits
Mass Advantage Extra (PPO) Evidence of Coverage
Additional Benefits
Over the Counter Savings Catalog
Non-Emergency Medical Transportation
Personal Emergency Response System
Medication Therapy Management (MTM)
Enrollment Documents
Complete Enrollment Kit (Ekit)
Enrollment Request Form with Instructions
Other
Low Income Subsidy (LIS) Rider