Medicare Advantage Plan Documents

Medicare Plan Documents

To view and print an evidence of coverage (EOC) or other plan documents, please select from the options below. If you would like to request a hard copy of a document mailed to you, please submit the form located below.

Annual Notice of Change Documents

SummaCare members receive the Annual Notice of Change (ANOC) documents in September of every year.

2027

2027 ANOC Amber - Updated October 1, 2026
2027 ANOC Emerald - Updated October 1, 2026
2027 ANOC Quartz - Updated October 1, 2026
2027 ANOC Ruby - Updated October 1, 2026
2027 ANOC Sapphire - Updated October 1, 2026
2027 ANOC Topaz - Updated October 1, 2026

2026

2026 ANOC Amber 1 – Updated October 1, 2025
2026 ANOC Amber 2 – Updated October 1, 2025
2026 ANOC Emerald – Updated October 1, 2025
2026 ANOC Garnet 1 – Updated October 1, 2025
2026 ANOC Garnet 2 – Updated October 1, 2025
2026 ANOC Ruby – Updated October 1, 2025
2026 ANOC Sapphire – Updated October 1, 2025
2026 ANOC Topaz – Updated October 1, 2025
2026 ANOC Summa Health HMO – Updated December 1, 2025
2026 ANOC Summa Health HMO-POS – Updated December 1, 2025

Evidence of Coverage

The Evidence of Coverage (EOC) document is a detailed explanation of the health and prescription drug benefits and services available to you. It includes information on how to use your coverage, details about your copays, a description of your member rights and responsibilities and a glossary of terms.

Please note: Information about SummaCare's grievance, coverage determination (including exceptions) and appeals processes can be found in Chapter 9 of each of the documents below.

2027

2027 EOC SummaCare Amber – Updated October 1, 2026
2027 EOC SummaCare Emerald – Updated October 1, 2026
2027 EOC SummaCare Quartz – Updated October 1, 2026
2027 EOC SummaCare Ruby – Updated October 1, 2026
2027 EOC SummaCare Sapphire – Updated October 1, 2026
2027 EOC SummaCare Topaz – Updated October 1, 2026

Summary of Benefits

The Summary of Benefits (SOB) document provides a summary of your medical and prescription drug benefits, including copay information. The SOB lists the primary features of your SummaCare plan. Please note, however, that it does not list every service that we cover or list every limitation or exclusion. For a complete list of benefits, refer to your EOC document.

2027

2027 Summary of Benefits - Amber - Updated October 1, 2026
2027 Summary of Benefits - Ruby - Updated October 1, 2026
2027 Summary of Benefits - Topaz and Quartz- Updated October 1, 2026
2027 Summary of Benefits - Sapphire and Emerald - Updated October 1, 2026

2026

2026 Summary of Benefits - Amber - Updated October 1, 2025
2026 Summary of Benefits - Garnet and Ruby - Updated October 1, 2025
2026 Summary of Benefits - Topaz and Quartz- Updated October 1, 2025
2026 Summary of Benefits - Sapphire and Emerald - Updated October 1, 2025
2026 Summary of Benefits - Summa Health Retiree - Updated October 1, 2025

Delta Dental Handbooks

The 2027 Delta Dental handbooks below provide a detailed explanation of your embedded and optional supplemental dental benefits, provider network and coverage amounts. (The handbooks labeled "Supplemental" are for those who buy up to optional supplemental dental for $38/month. Handbooks that do not have the word supplemental are for the embedded benefit.)

2027

2027 Delta Dental Handbook Amber Embedded 1083 1014 - Updated October 15, 2026
2027 Delta Dental Handbook Amber Optional 1083 0014 - Updated October 15, 2026
2027 Delta Dental Handbook Sapphire Ruby Emerald Quartz Embedded 1083 1007 1009 1011 1013 - Updated October 15, 2026
2027 Delta Dental Handbook Sapphire Ruby Emerald Quartz Optional 1083 0007 0009 0011 0013 - Updated October 15, 2026
2027 Delta Dental Handbook Topaz Embedded 1083 1008 - Updated October 15, 2026
2027 Delta Dental Handbook Topaz Optional 1083 0008 - Update October 15, 2026

2026

Request Member Materials

To request a hard copy of an evidence of coverage document, provider directory or formulary be mailed to you, please call SummaCare Member Services at 330.996.8885 (TTY 711) or 800.996.6250 (TTY 711) or complete the online request form.

Questions? We're here to help.

Phone

330.996.8885 (TTY 711) Member Services

1.800.996.6250 (TTY 711) Toll Free

Email

[email protected] Existing Members

[email protected] All Other Inquiries

Hours

Season	Days	Times
Oct 1 – Mar 31	7 days a week	8:00 a.m. – 8:00 p.m.
Apr 1 – Sep 30	Mon – Fri	8:00 a.m. – 8:00 p.m.

Outside these hours, you may leave us a message and a representative will return your call the next business day.