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 Allwell from Home State Health 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 Allwell from Home State Health 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 (HMO) H1664-001

Barry, Christian, Dallas, Greene, Jasper, Laclede, Lawrence, McDonald, Newton, Polk, Stone, Taney, Webster and Wright

Wellcare No Premium (HMO) H1664-004 Crawford, Franklin, Jefferson, Lincoln, St. Charles, St. Louis, St. Louis City, Warren and Washington
Wellcare Giveback (HMO) H1664-006 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright
Wellcare Assist (HMO) H1664-007 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright


For HMO D-SNP Members:

Plan Name  CMS# County Summary of Benefits
Wellcare Dual Access (HMO D-SNP) H1664 - 005 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright

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 (HMO) H1664-001

Barry, Cass, Christian, Clay, Dade, Dallas, Douglas, Greene, Jackson, Jasper, Laclede, Lawrence, McDonald, Newton, Platte, Polk, Stone, Taney, Webster, Wright

Wellcare No Premium (HMO) H1664-004 Crawford, Franklin, Jefferson, Lincoln, St. Charles, St. Louis, St. Louis City, Warren and Washington
Wellcare Giveback (HMO) H1664-006 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright
Wellcare Assist (HMO) H1664-007 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright


For HMO D-SNP Members:

Plan Name  CMS# County Evidence of Coverage
Wellcare Dual Access (HMO D-SNP) H1664 - 005 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright

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 (HMO) H1664-001 Barry, Christian, Dallas, Greene, Jasper, Laclede, Lawrence, McDonald, Newton, Polk, Stone, Taney, Webster and Wright
Allwell Medicare (HMO) to Wellcare No Premium (HMO) H1664-002 - H1664-001 Barry, Christian, Dallas, Greene, Jasper, Laclede, Lawrence, McDonald, Newton, Polk, Stone, Taney, Webster and Wright
Wellcare No Premium (HMO) H1664-004 Crawford, Franklin, Jefferson, Lincoln, St. Charles, St. Louis, St. Louis City, Warren and Washington
Wellcare Giveback (HMO) H1664-006 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright
Allwell Medicare Boost (HMO) to Wellcare Giveback (HMO) H1664-08 - H1664-006

Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright
Allwell Medicare Boost (HMO) to Wellcare Giveback (HMO)
H1664-10 - H1664-006
Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright
Wellcare Assist (HMO) H1664-007 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright
Allwell Medicare Complement (HMO) to Wellcare Assist (HMO) H1664-009 - H1664-007 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright
Allwell Medicare Complement (HMO) to Wellcare Assist (HMO) H1664-011 - H1664-007 Barry, Cass, Christian, Clay, Crawford, Dade, Dallas, Douglas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster, Wright


For HMO D-SNP Members:

Plan Name  CMS# County Annual Notice Of Changes
Wellcare Dual Access (HMO D-SNP) H1664 - 005 Barry, Cass, Christian, Clay, Crawford, Dallas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster and Wright