With over 100 years of care experience, we created and designed this health plan for what matters most - you. As a member, you can find information about your Ascension Personalized Care health plan including benefits and coverage, in-network doctors, and additional resources for care.

Featured Members Resources

Ascension_Personalized_Care_ACA_health_plans_agents_members_forms

Agent and member forms

View important forms and general resources for agents and members.

Appeal and claim forms

Ascension Personalized Care Member Appeal Request Form

Ascension Personalized Care Self-Reimbursement Claim Form
Evidence of Coverage

2024

Ascension Personalized Care EOC - Indiana 2024

Ascension Personalized Care EOC - Kansas 2024

Ascension Personalized Care EOC - Tennessee 2024

Ascension Personalized Care EOC - Texas 2024

2023

Ascension Personalized Care EOC - Indiana 2023

Ascension Personalized Care EOC - Kansas 2023

Ascension Personalized Care EOC - Michigan 2023

Ascension Personalized Care EOC - Tennessee 2023

Ascension Personalized Care EOC - Texas 2023

2022

Ascension Personalized Care EOC - Indiana 2022

Ascension Personalized Care EOC - Kansas 2022

Ascension Personalized Care EOC - Michigan 2022
Managing private information

APC Authorization for Agent Access*
Request for Appointment of Personal Representative
Request for Confidential Communications and Restrictions
Request to Terminate Personal Representative - COMING SOON
Request to Terminate Confidential Communications and Restrictions
Authorization to Disclose Protected Health Information
Request for Accounting of Disclosures - COMING SOON
Request for Amendment of Private Information - COMING SOON

*Full medical access form available upon request
National ancillary list

Ascension Personalized Care offers a network of national ancillary providers to ensure convenient access to high quality, cost-effective services, including but not limited to medical supplies, durable medical equipment (DME) and other services. In addition to these national vendors, locally based participating doctors may be available. Please check the Ascension Personalized Care provider directory to find a local doctor.

APC National Ancillary List
Out-of-network claim forms

Out-of-network request form
Schedule of Benefits

2024 Schedule of Benefits

2023 Schedule of Benefits

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