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	Summary of Benefits, H9630-001 - English (PDF) Summary of Benefits, H9630-001 - Spanish (PDF)
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	Summary of Benefits, H9630-002 - English (PDF) Summary of Benefits, H9630-002 - Spanish (PDF)
Wellcare No Premium Select (HMO)	H9630-003	Benton and Washington counties	Summary of Benefits, H9630-003 - English (PDF) Summary of Benefits, H9630-003 - Spanish (PDF)
Wellcare No Premium Medicare (HMO)	H9630-004	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline	Summary of Benefits, H9630-004 - English (PDF) Summary of Benefits, H9630-004 - Spanish (PDF)
Wellcare Assist (HMO)	H9630-005	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline	Summary of Benefits, H9630-005 - English (PDF) Summary of Benefits, H9630-005 - Spanish (PDF)
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	Summary of Benefits, H9630-006 - English (PDF) Summary of Benefits, H9630-006- Spanish (PDF)
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	Summary of Benefits, H9630-008 - English (PDF) Summary of Benefits, H9630-008- Spanish (PDF)
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	Summary of Benefits, H9630-009 - English (PDF) Summary of Benefits, H9630-009- Spanish (PDF)

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	Summary of Benefits, H9630-010 - English (PDF) Summary of Benefits, H9630-010- Spanish (PDF)
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	Summary of Benefits, H9630-011 - English (PDF) Summary of Benefits, H9630-011- Spanish (PDF)

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	Evidence of Coverage, H9630-001 - English (PDF) Evidence of Coverage, H9630-001 - Spanish (PDF)
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	Evidence of Coverage, H9630-002 - English (PDF) Evidence of Coverage, H9630-002 - Spanish (PDF)
Wellcare No Premium Select (HMO)	H9630-003	Benton and Washington counties	Evidence of Coverage, H9630-003 - English (PDF) Evidence of Coverage, H9630-003 - Spanish (PDF)
Wellcare No Premium Medicare (HMO)	H9630-004	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline	Evidence of Coverage, H9630-004 - English (PDF) Evidence of Coverage, H9630-004 - Spanish (PDF)
Wellcare Assist (HMO)	H9630-005	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline	Evidence of Coverage, H9630-005 - English (PDF) Evidence of Coverage, H9630-005 - Spanish (PDF)
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	Evidence of Coverage, H9630 - 006 - English (PDF) Evidence of Coverage, H9630 - 006 - Spanish (PDF)
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	Evidence of Coverage, H9630 - 008 - English (PDF) Evidence of Coverage, H9630 - 008 - Spanish (PDF)
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	Evidence of Coverage, H9630 - 009 - English (PDF) Evidence of Coverage, H9630 - 009 - Spanish (PDF)

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	Evidence of Coverage, H9630 - 010 - English (PDF) Evidence of Coverage, H9630 - 010 - Spanish (PDF)
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	Evidence of Coverage, H9630 - 011 - English (PDF) Evidence of Coverage, H9630 - 011 - Spanish (PDF)

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	Annual Notice of Changes, H9630-001 - English (PDF) Annual Notice of Changes, H9630-001 - Spanish (PDF)
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	Annual Notice of Changes, H9630-002 - English (PDF) Annual Notice of Changes, H9630-002 - Spanish (PDF)
Wellcare No Premium Select (HMO)	H9630-003	Benton and Washington counties	Annual Notice of Changes, H9630-003 - English (PDF) Annual Notice of Changes, H9630-003 - Spanish (PDF)
Wellcare No Premium Medicare (HMO)	H9630-004	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline	Annual Notice of Changes, H9630-004 - English (PDF) Annual Notice of Changes, H9630-004 - Spanish (PDF)
Wellcare Assist (HMO)	H9630-005	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski, Saline	Annual Notice of Changes, H9630-005 - English (PDF) Annual Notice of Changes, H9630-005 - Spanish (PDF)
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	Annual Notice of Changes, H9630-006 - English (PDF) Annual Notice of Changes, H9630-006 - Spanish (PDF)
Wellcare Giveback (HMO)	H9630-008		Annual Notice of Changes, H9630-008 - English (PDF) Annual Notice of Changes, H9630-008 - Spanish (PDF)
Wellcare Patriot No Premium (HMO)	H9630-009		Annual Notice of Changes, H9630-009 - English (PDF) Annual Notice of Changes, H9630-009 - Spanish (PDF)

Plan Name	CMS #	County	Summary of Benefits
Allwell 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	Summary of Benefits H9630-001- English (PDF)
Allwell Medicare (HMO)	H9630-002	Benton, Clark, Conway, Craighead, Crawford, Faulkner, Garland, Greene, Hot Spring, Independence, Jackson, Lonoke, Pope, Pulaski, Saline, Sebastian, Washington, White, Woodruff	Summary of Benefits H9630-002- English (PDF)
Allwell Medicare Select (HMO)	H9630-003	Benton and Washington counties	Summary of Benefits H9630-003- English (PDF)
Allwell Medicare (HMO)	H9630-004	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski and Saline counties	Summary of Benefits H9630-004- English (PDF)
Allwell Medicare Premier (HMO)	H9630-005	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski and Saline counties	Summary of Benefits H9630-005- English (PDF)
Allwell Medicare Premier (HMO)	H9630-006	Benton, Carroll, Clay, Cleburne, Crawford, Crittenden, Cross, Franklin, Fulton, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Madison, Mississippi, Newton, Perry, Poinsett, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, and Yell counties	Summary of Benefits H9630-006- English (PDF)
Allwell Medicare Boost (HMO)	H9630-008	Baxter, Benton, Boone, Carroll, Clark, Clay, Cleburne, Conway, Craighead, Crawford, Crittenden, Cross, Faulkner, Franklin, Fulton, Garland, Greene, Hot Spring, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Lonoke, Madison, Marion, Mississippi, Newton, Perry, Poinsett, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White , Woodruff and Yell counties	Summary of Benefits H9630-008- English (PDF)
Allwell Medicare Simple (HMO)	H9630-009	Baxter, Benton, Boone, Carroll, Clark, Clay, Cleburne, Conway, Craighead, Crawford, Crittenden, Cross, Faulkner, Franklin, Fulton, Garland, Greene, Hot Spring, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Lonoke, Madison, Marion, Mississippi, Newton, Perry, Poinsett, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White , Woodruff and Yell counties	Summary of Benefits H9630-009- English (PDF)

Plan Name	CMS #	County	Evidence of Coverage
Allwell 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	Evidence of Coverage H9630-001- English (PDF)
Allwell Medicare (HMO)	H9630-002	Benton, Clark, Conway, Craighead, Crawford, Faulkner, Garland, Greene, Hot Spring, Independence, Jackson, Lonoke, Pope, Pulaski, Saline, Sebastian, Washington, White, Woodruff	Evidence of Coverage H9630-002- English (PDF)
Allwell Medicare Select (HMO)	H9630-003	Benton and Washington counties	Evidence of Coverage H9630-003- English (PDF) Evidence of Coverage H9630-003- Spanish (PDF)
Allwell Medicare (HMO)	H9630-004	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski and Saline counties	Evidence of Coverage H9630-004- English (PDF)
Allwell Medicare Premier (HMO)	H9630-005	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski and Saline counties	Evidence of Coverage H9630-005- English (PDF)
Allwell Medicare Premier (HMO)	H9630-006	Benton, Carroll, Clay, Cleburne, Crawford, Crittenden, Cross, Franklin, Fulton, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Madison, Mississippi, Newton, Perry, Poinsett, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, and Yell counties	Evidence of Coverage H9630-006- English (PDF)
Allwell Medicare Boost (HMO)	H9630-008	Baxter, Benton, Boone, Carroll, Clark, Clay, Cleburne, Conway, Craighead, Crawford, Crittenden, Cross, Faulkner, Franklin, Fulton, Garland, Greene, Hot Spring, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Lonoke, Madison, Marion, Mississippi, Newton, Perry, Poinsett, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White , Woodruff and Yell counties	Evidence of Coverage H9630-008- English (PDF)
Allwell Medicare Simple (HMO)	H9630-009	Baxter, Benton, Boone, Carroll, Clark, Clay, Cleburne, Conway, Craighead, Crawford, Crittenden, Cross, Faulkner, Franklin, Fulton, Garland, Greene, Hot Spring, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Lonoke, Madison, Marion, Mississippi, Newton, Perry, Poinsett, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White , Woodruff and Yell counties	Evidence of Coverage H9630-009- English (PDF)

Plan Name	County	Summary of Benefits
Allwell Medicare (HMO)	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	Summary of Benefits 5000-1001 (PDF) Certificate of Benefits 5000- 1001 (PDF)
Allwell Medicare (HMO)	Benton, Clark, Conway, Craighead, Crawford, Faulkner, Garland, Greene, Hot Spring, Independence, Jackson, Lonoke, Pope, Pulaski, Saline, Sebastian, Washington, White, Woodruff	Summary of Benefits 5000-0002 (PDF) Certificate of Benefits 5000-0002 (PDF)
Allwell Medicare Select (HMO)	Benton and Washington counties	Summary of Benefits 5000-0003 (PDF) Certificate of Benefits 5000-0003 (PDF)
Allwell Medicare (HMO)	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski and Saline counties	Summary of Benefits 5000-0004 (PDF) Certificate of Benefits 5000-0004 (PDF)
Allwell Medicare Premier (HMO)	Baxter, Boone, Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Marion, Pope, Pulaski and Saline counties	Summary of Benefits 5000-0005 (PDF) Certificate of Benefits 5000-0005 (PDF)
Allwell Medicare Premier (HMO)	Benton, Carroll, Clay, Cleburne, Crawford, Crittenden, Cross, Franklin, Fulton, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Madison, Mississippi, Newton, Perry, Poinsett, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White, Woodruff, and Yell counties	Summary of Benefits 5000-0006 (PDF) Certificate of Benefits 5000-0006 (PDF)
Allwell Medicare Premier (HMO)	Baxter, Benton, Boone, Carroll, Clark, Clay, Cleburne, Conway, Craighead, Crawford, Crittenden, Cross, Faulkner, Franklin, Fulton, Garland, Greene, Hot Spring, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Lonoke, Madison, Marion, Mississippi, Newton, Perry, Poinsett, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White , Woodruff and Yell counties	Summary of Benefits 5000-0008 (PDF) Certificate of Benefits 5000-0008 (PDF)
Allwell Medicare Premier (HMO)	Baxter, Benton, Boone, Carroll, Clark, Clay, Cleburne, Conway, Craighead, Crawford, Crittenden, Cross, Faulkner, Franklin, Fulton, Garland, Greene, Hot Spring, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Lonoke, Madison, Marion, Mississippi, Newton, Perry, Poinsett, Pope, Prairie, Pulaski, Randolph, Saline, Scott, Searcy, Sebastian, Sharp, St. Francis, Stone, Van Buren, Washington, White , Woodruff and Yell counties	Summary of Benefits 5000-0009 (PDF) Certificate of Benefits 5000-0009 (PDF)

Plan Benefit Materials |

Plan Materials and Forms

For HMO Members:

For DSNP Members:

For HMO Members:

For HMO Members:

Plan Benefit Materials

For HMO Members:

For HMO Members:

For HMO Members:

Dental Benefit Summary:

Plan Benefit Materials |

Plan Materials and Forms

Summary of Benefits (SB)

For HMO Members:

For DSNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

Annual Notice of Changes (ANOC)

For HMO Members:

Over-The-Counter Benefits

Plan Benefit Materials

Summary of Benefits (SB)

For HMO Members:

Evidence Of Coverage (EOC)

For HMO Members:

Annual Notice of Changes (ANOC)

For HMO Members:

Dental Benefits

Dental Benefit Summary:

Acupuncture National Coverage

Over-The-Counter Benefits