Plan Benefit Materials |

Plan Materials and Forms

 

Information about plan benefits, services, and drug costs can be found in your plan materials.

Look at your Wellcare By Allwell member ID card for your plan number and type to view materials for your plan. 

  • View a sample of an Wellcare By Allwell Member ID Card to see where this information is located.

You can also look for plan materials based on the plan name and the county you live in.

If you don’t have a Wellcare By Allwell ID card or have questions about plan materials, give us a call. We’re here to help.

This booklet gives you a summary of costs and coverage in your plan. 

Please select the document for your plan and county:

For HMO Members:

Plan Name CMS# County Summary of Benefits
Wellcare No Premium Medicare (HMO) H9630-001 Arkansas, Benton, Bradley, Calhoun, Carroll, Chicot, Clay, Cleburne, Cleveland, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Franklin, Fulton, Grant, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Madison, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell
Wellcare No Premium (HMO) H9630-002 Benton, Clark, Conway, Craighead, Crawford, Faulkner, Garland, Greene, Hot Spring, Independence, Jackson, Lonoke, Pope, Pulaski, Saline, Sebastian, Washington, White, Woodruff
Wellcare No Premium Select (HMO) H9630-003 Benton and Washington counties
Wellcare No Premium Medicare (HMO) H9630-004 Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline
Wellcare Assist (HMO) H9630-005

Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline
Wellcare Assist (HMO) H9630 - 006 Arkansas, Benton, Bradley, Calhoun, Carroll, Chicot, Clay, Cleburne, Cleveland, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Franklin, Fulton, Grant, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Madison, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell
Wellcare Giveback (HMO) H9630-008 Arkansas, Baxter, Benton, Boone, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Faulkner, Franklin, Fulton, Garland, Grant, Greene, Hot Spring, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Lonoke, Madison, Marion, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell
Wellcare Patriot No Premium (HMO) H9630-009 Arkansas, Baxter, Benton, Boone, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Faulkner, Franklin, Fulton, Garland, Grant, Greene, Hot Spring, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Lonoke, Madison, Marion, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell

For DSNP Members:

DSNP
Wellcare Dual Access (HMO D-SNP) H9630-010 Arkansas, Baxter, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crittenden, Cross, Dallas, Desha, Drew, Fulton, Garland, Grant, Greene, Hot Spring, Independence, Izard, Jackson, Jefferson, Lawrence, Lee, Lincoln, Lonoke, Marion, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Pulaski, Randolph, Saline, Searcy, Sharp, St. Francis, Stone, Van Buren, White, Woodruff, Yell
Wellcare Dual Liberty (HMO D-SNP) H9630-011 Arkansas, Baxter, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crittenden, Cross, Dallas, Desha, Drew, Fulton, Garland, Grant, Greene, Hot Spring, Independence, Izard, Jackson, Jefferson, Lawrence, Lee, Lincoln, Lonoke, Marion, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Pulaski, Randolph, Saline, Searcy, Sharp, St. Francis, Stone, Van Buren, White, Woodruff, Yell

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:

For HMO Members:

 

Plan Name

CMS# County Evidence of Coverage 
Wellcare No Premium Medicare (HMO) H9630-001

Arkansas, Benton, Bradley, Calhoun, Carroll, Chicot, Clay, Cleburne, Cleveland, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Franklin, Fulton, Grant, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Madison, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell

Wellcare No Premium (HMO) H9630-002

Benton, Clark, Conway, Craighead, Crawford, Faulkner, Garland, Greene, Hot Spring, Independence, Jackson, Lonoke, Pope, Pulaski, Saline, Sebastian, Washington, White, Woodruff

Wellcare No Premium Select (HMO) H9630-003

Benton and Washington counties


Wellcare No Premium Medicare (HMO)
H9630-004 Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline
Wellcare Assist (HMO) H9630-005 Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline
Wellcare Assist (HMO) H9630-006 Arkansas, Benton, Bradley, Calhoun, Carroll, Chicot, Clay, Cleburne, Cleveland, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Franklin, Fulton, Grant, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Madison, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell
Wellcare Giveback (HMO) H9630-008 Arkansas, Baxter, Benton, Boone, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Faulkner, Franklin, Fulton, Garland, Grant, Greene, Hot Spring, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Lonoke, Madison, Marion, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell
Wellcare Patriot No Premium (HMO) H9630-009 Arkansas, Baxter, Benton, Boone, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Faulkner, Franklin, Fulton, Garland, Grant, Greene, Hot Spring, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Lonoke, Madison, Marion, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell

 

DSNP

Wellcare Dual Access (HMO D-SNP) H9630-010 Arkansas, Baxter, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crittenden, Cross, Dallas, Desha, Drew, Fulton, Garland, Grant, Greene, Hot Spring, Independence, Izard, Jackson, Jefferson, Lawrence, Lee, Lincoln, Lonoke, Marion, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Pulaski, Randolph, Saline, Searcy, Sharp, St. Francis, Stone, Van Buren, White, Woodruff, Yell
Wellcare Dual Liberty (HMO D-SNP) H9630-011 Arkansas, Baxter, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crittenden, Cross, Dallas, Desha, Drew, Fulton, Garland, Grant, Greene, Hot Spring, Independence, Izard, Jackson, Jefferson, Lawrence, Lee, Lincoln, Lonoke, Marion, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Pulaski, Randolph, Saline, Searcy, Sharp, St. Francis, Stone, Van Buren, White, Woodruff, Yell

This booklet will tell you about changes to your plan’s costs and benefits for the coming year.

Please select the document for your plan and county:

For HMO Members:

Plan Name  CMS# County Annual Notice Of Changes
Wellcare No Premium Medicare (HMO) H9630-001 Arkansas, Benton, Bradley, Calhoun, Carroll, Chicot, Clay, Cleburne, Cleveland, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Franklin, Fulton, Grant, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Madison, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell
Wellcare No Premium (HMO) H9630-002 Benton, Clark, Conway, Craighead, Crawford, Faulkner, Garland, Greene, Hot Spring, Independence, Jackson, Lonoke, Pope, Pulaski, Saline, Sebastian, Washington, White, Woodruff
Wellcare No Premium Select (HMO) H9630-003 Benton and Washington counties
Wellcare No Premium Medicare (HMO) H9630-004 Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline
Wellcare Assist (HMO) H9630-005 Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline
Wellcare Assist (HMO) H9630-006 Arkansas, Benton, Bradley, Calhoun, Carroll, Chicot, Clay, Cleburne, Cleveland, Crawford, Crittenden, Cross, Dallas, Desha, Drew, Franklin, Fulton, Grant, Independence, Izard, Jackson, Jefferson, Johnson, Lawrence, Lee, Lincoln, Logan, Madison, Mississippi, Monroe, Montgomery, Nevada, Newton, Ouachita, Perry, Phillips, Pike, Poinsett, Polk, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, Yell
Wellcare Giveback (HMO) H9630-008  
Wellcare Patriot No Premium (HMO) H9630-009