Medicare Advantage Plan Documents

Medicare Plan Documents

To view and print an 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.

2025

2025 ANOC Amber 1 – Updated October 1, 2024
2025 ANOC Amber 2 – Updated October 1, 2024
2025 ANOC Emerald – Updated October 1, 2024
2025 ANOC Garnet 1 – Updated October 1, 2024
2025 ANOC Garnet 2 – Updated October 1, 2024
2025 ANOC Jade 1 – Updated October 1, 2024
2025 ANOC Jade 2 – Updated October 1, 2024
2025 ANOC Ruby – Updated October 1, 2024
2025 ANOC Sapphire – Updated October 1, 2024
2025 ANOC Topaz – Updated October 1, 2024

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.

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.

2025

2025 Summary of Benefits - Amber - Updated October 1, 2024
2025 Summary of Benefits - Topaz, Garnet and Ruby - Updated October 1, 2024
2025 Summary of Benefits - Jade - Updated October 1, 2024
2025 Summary of Benefits - Sapphire and Emerald - Updated October 1, 2024

Delta Dental Handbooks

The 2025 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 $37/month. Handbooks that do not have the word supplemental are for the embedded benefit.)

2025

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 or 800.996.6250 (TTY 711) or complete the online request form.

Questions? We are here to help.

By Phone

Sales:
330.996.8440

Member Services:
330.996.8885

toll free
800.996.6250
(TTY 711)

Hours

From October 1 - March 31
8:00 a.m. to 8:00 p.m.
seven days a week

From April 1 - September 30
8:00 a.m. to 8:00 p.m.
Monday - Friday

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