On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.

Plan Materials and Forms

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

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

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, Barton, Bates, Cass, Christian, Clay, Clinton, Dade, Dallas, Douglas, Greene, Henry, Jackson, Jasper, Johnson, Laclede, Lafayette, Lawrence, McDonald, Newton, Platte, Polk, Ray, Stone, Taney, Vernon, Webster, Wright	Summary of Benefits H1664- 001 - English (PDF)
Wellcare No Premium (HMO)	H1664-004	Audrain, Boone, Callaway, Cole, Cooper, Crawford, Franklin, Gasconade, Jefferson, Lincoln, Maries, Miller, Moniteau, Montgomery, Morgan, Osage, St. Charles, St. Louis, St. Louis City, Warren, Washington	Summary of Benefits H1664 - 004 - English (PDF)
Wellcare Giveback (HMO)	H1664-006	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 H1664 - 006 - English (PDF)
Wellcare Assist (HMO)	H1664-007	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 H1664 - 007 - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Summary of Benefits
Wellcare Dual Access (HMO D-SNP)	H1664 - 005	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 -H1664 - 005 - English (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 (HMO)	H1664-001	Barry, Barton, Bates, Cass, Christian, Clay, Clinton, Dade, Dallas, Douglas, Greene, Henry, Jackson, Jasper, Johnson, Laclede, Lafayette, Lawrence, McDonald, Newton, Platte, Polk, Ray, Stone, Taney, Vernon, Webster, Wright	Evidence of Coverage H1664 - 001- English (PDF) Dental Benefits Detail - English (PDF)
Wellcare No Premium (HMO)	H1664-004	Audrain, Boone, Callaway, Cole, Cooper, Crawford, Franklin, Gasconade, Jefferson, Lincoln, Maries, Miller, Moniteau, Montgomery, Morgan, Osage, St. Charles, St. Louis, St. Louis City, Warren, Washington	Evidence of Coverage H1664 - 004 - English (PDF) Dental Benefits Detail - English (PDF)
Wellcare Giveback (HMO)	H1664-006	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	Evidence of Coverage H1664 - 006 - English (PDF) Dental Benefits Detail - English (PDF)
Wellcare Assist (HMO)	H1664-007	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	Evidence of Coverage H1664 - 007 - English (PDF) Dental Benefits Detail - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Evidence of Coverage
Wellcare Dual Access (HMO D-SNP)	H1664 - 005	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	Evidence of Coverage -H1664 - 005 - English (PDF) Dental Benefits Detail - English (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 (HMO)	H1664-001	Barry, Barton, Bates, Cass, Christian, Clay, Clinton, Dade, Dallas, Douglas, Greene, Henry, Jackson, Jasper, Johnson, Laclede, Lafayette, Lawrence, McDonald, Newton, Platte, Polk, Ray, Stone, Taney, Vernon, Webster, Wright	Annual Notice of Changes, H1664-001 - English (PDF)
Wellcare No Premium (HMO)	H1664-004	Audrain, Boone, Callaway, Cole, Cooper, Crawford, Franklin, Gasconade, Jefferson, Lincoln, Maries, Miller, Moniteau, Montgomery, Morgan, Osage, St. Charles, St. Louis, St. Louis City, Warren, Washington	Annual Notice of Changes H1664-004 - English (PDF)
Wellcare Giveback (HMO)	H1664-006	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 H1664-006 - English (PDF)
Wellcare Assist (HMO)	H1664-007	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 H1664-007 - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Annual Notice Of Changes
Wellcare Dual Access (HMO D-SNP)	H1664 - 005	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 H1664-005 - English (PDF)

Medicare Step Therapy Part B (PDF)

Covered Diabetes Testing Supplies

2024 Original Medicare Defined Cost Share Amounts and Premiums (PDF)

Plan Benefit Materials |

Plan Materials and Forms

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

Plan Benefit Materials

HMO

Wellcare Simple (HMO) H1664-001

Wellcare Giveback (HMO-POS) H1664-006

HMO D-SNP

Wellcare Dual Access (HMO-POS D-SNP) H1664-005

Wellcare Dual Reserve (HMO-POS D-SNP) H1664-012

Addtional Forms

Plan Benefit Materials |

Plan Materials and Forms

Summary of Benefits (SB)

For HMO Members:

For HMO D-SNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D-SNP Members:

Annual Notice of Changes (ANOC)

For HMO Members:

For HMO D-SNP Members:

Step Therapy Part B

Covered Diabetes Testing Supplies

Over-the Counter Catalog and Healthy Food

2024 AHIP Flyer

Plan Benefit Materials

HMO

Wellcare Simple (HMO) H1664-001

Plan Benefits

Wellcare Giveback (HMO-POS) H1664-006

Plan Benefits

HMO D-SNP

Wellcare Dual Access (HMO-POS D-SNP) H1664-005

Plan Benefits

Wellcare Dual Reserve (HMO-POS D-SNP) H1664-012

Plan Benefits

Addtional Forms

Step Therapy Part B

Covered Diabetes Testing Supplies

Over-the Counter Catalog and Healthy Food