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- Mail Order Service
- Specialty Pharmacy
- Coverage Determinations and Redeterminations
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Plan Benefit Materials |
Plan Benefit Materials
Learn about your plan and all that it has to offer by reviewing helpful plan documents such as the Annual Notice of Change (ANOC), Summary of Benefits, and Evidence of Coverage.
To get started, locate your plan in the list of plans below and select “Plan Benefits.”
HMO
Additional Forms
Plan Benefit Materials
Learn about your plan and all that it has to offer by reviewing helpful plan documents such as the Annual Notice of Change (ANOC), Summary of Benefits, and Evidence of Coverage.
To get started, locate your plan in the list of plans below and select “Plan Benefits.”
HMO
Wellcare Simple (HMO- POS) H1664-001
Counties: Audrain, Barry, Barton, Bates, Boone, Callaway, Cass, Christian, Clay, Clinton, Cole, Cooper, Crawford, Dade, Dallas, Douglas, Franklin, Gasconade, Greene, Henry, Jackson, Jasper, Jefferson, Johnson, Laclede, Lafayette, Lawrence, Lincoln, Maries, McDonald, Miller, Moniteau, Montgomery, Morgan, Newton, Osage, Platte, Polk, Ray, St. Charles, St. Louis, St. Louis City, Stone, Taney, Vernon, Warren, Washington, Webster, Wright
Annual Notice of Changes
- Annual Notice of Change: Wellcare Assist (HMO) to Wellcare Simple (HMO-POS) - English (PDF)
- Annual Notice of Change: Wellcare No Premium (HMO) H1664-001 to Wellcare Simple (HMO-POS) H1664-001 - English (PDF)
- Annual Notice of Change: Wellcare No Premium (HMO) H1664-004 to Wellcare Simple (HMO-POS) H1664-001 - English (PDF)
Summary of Benefits
Evidence of Coverage
Wellcare Giveback (HMO-POS) H1664-006
Counties: Audrain, Barry, Barton, Bates, Boone, Callaway, Cass, Christian, Clay, Clinton, Cole, Cooper, Crawford, Dade, Dallas, Douglas, Franklin, Gasconade, Greene, Henry, Jackson, Jasper, Jefferson, Johnson, Laclede, Lafayette, Lawrence, Lincoln, Maries, McDonald, Miller, Moniteau, Montgomery, Morgan, Newton, Osage, Platte, Polk, Ray, St. Charles, St. Louis, St. Louis City, Stone, Taney, Vernon, Warren, Washington, Webster, Wright
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
HMO D-SNP
Wellcare Dual Access (HMO-POS D-SNP) H1664-005
Counties: Audrain, Barry, Barton, Bates, Boone, Callaway, Cass, Christian, Clay, Clinton, Cole, Cooper, Crawford, Dade, Dallas, Douglas, Franklin, Gasconade, Greene, Henry, Jackson, Jasper, Jefferson, Johnson, Laclede, Lafayette, Lawrence, Lincoln, Maries, McDonald, Miller, Moniteau, Montgomery, Morgan, Newton, Osage, Platte, Polk, Ray, St. Charles, St. Louis, St. Louis City, Stone, Taney, Vernon, Warren, Washington, Webster, Wright
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Dual Reserve (HMO-POS D-SNP) H1664-012
Counties: Audrain, Barry, Barton, Bates, Boone, Callaway, Cass, Christian, Clay, Clinton, Cole, Cooper, Crawford, Dade, Dallas, Douglas, Franklin, Gasconade, Greene, Henry, Jackson, Jasper, Jefferson, Johnson, Laclede, Lafayette, Lawrence, Lincoln, Maries, McDonald, Miller, Moniteau, Montgomery, Morgan, Newton, Osage, Platte, Polk, Ray, St. Charles, St. Louis, St. Louis City, Stone, Taney, Vernon, Warren, Washington, Webster, Wright
Summary of Benefits
Evidence of Coverage
Additional Forms
If you have questions please, contact Member Services.
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