Plan Documents

Access Champion Health Plan documents by plan year, state, language and plan name where applicable. Plan Documents can be filtered by category including Summary of Benefits, Evidence of Coverage, Annual Notice of Change and more.

Plan Year

State

Language

Plan Name

On this page

2027 CA Summary of Benefits (SBs) – Champion Ally (HMO) H6170-007 (English)

2027 California Summary of Benefits (SoB) for the Champion Ally Plan (HMO) H6170-007

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2027 CA Summary of Benefits (SBs) – Champion Home (HMO C-SNP) H6170-016 (English)

Summary of Benefits (SoB) for 2027 California Champion Home Plan (HMO C-SNP) H6170-016 Eligible Counties: Fresno, Imperial, Kern, Los Angeles, Madera, Orange, Riverside, San Bernardino and San Diego Counties

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2026 Over-the-Counter Benefits Catalog (English)

2026 OTC Item Catalog (CVS Pharmacy)

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Clinical Criteria – Nevada (Spanish)

Criterios clínicos para la toma de decisiones de gestión de la utilización (UM) – Nevada (Spanish)

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Clinical Criteria

Clinical Criteria for Utilization Management (UM) Decision-Making

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2026 Champion Plus Plan Behavioral Health HMO C-SNP Evidence of Coverage (EOC) – California (Spanish)

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2026 Champion Plus Plan Behavioral Health HMO C-SNP Evidence of Coverage (EOC) – California (English)

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2026 Champion Advantage HMO-POS C-SNP Evidence of Coverage (EOC) – Nevada (Spanish)

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2026 Champion Advantage HMO-POS C-SNP Evidence of Coverage (EOC) – Nevada (English)

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2026 Champion Connect HMO-POS C-SNP Evidence of Coverage (EOC) – Nevada (Spanish)

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2026 Champion Connect HMO-POS C-SNP Evidence of Coverage (EOC) – Nevada (English)

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2026 Champion Select HMO-POS C-SNP Evidence of Coverage (EOC) – Nevada (Spanish)

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2026 Champion Select HMO-POS C-SNP Evidence of Coverage (EOC) – Nevada (English)

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2026 Champion Ally (HMO) Evidence of Coverage (EOC) – Nevada – Spanish

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2026 Champion Ally (HMO) Evidence of Coverage (EOC) – Nevada – English

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2026 Champion Care HMO C-SNP Evidence of Coverage (EOC) – Nevada (Spanish)

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2026 Champion Care HMO C-SNP Evidence of Coverage (EOC) – Nevada (English)

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2026 Champion Choice HMO C-SNP Evidence of Coverage (EOC) – Nevada (Spanish)

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2026 Champion Choice HMO C-SNP Evidence of Coverage (EOC) – Nevada (English)

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2026 Champion Plus HMO C-SNP Evidence of Coverage (EOC) – Nevada (Spanish)

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