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 parish:

For HMO Members:

Plan Name	CMS#	Parish	Summary of Benefits
Wellcare No Premium Medicare (HMO)	H5117-003	Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge	Summary of Benefits, H5117-003 - English (PDF) Summary of Benefits, H5117-003 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	Parish	Summary of Benefits
Wellcare Dual Access Medicare (HMO D-SNP)	H5117-004	Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge	Summary of Benefits, H5117-004 - English (PDF) Summary of Benefits, H5117-004 - 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 parish:

For HMO Members:

Plan Name	CMS#	Parish	Evidence of Coverage
Wellcare No Premium Medicare (HMO)	H5117-003	Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge	Evidence of Coverage, H5117-003 - English (PDF) Evidence of Coverage, H5117-003 - Spanish (PDF)

Plan Name

CMS#

Parish

Evidence of Coverage

Wellcare No Premium Medicare (HMO)

H5117-003

Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge

Evidence of Coverage, H5117-003 - English (PDF)

Evidence of Coverage, H5117-003 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	Parish	Evidence of Coverage
Wellcare Dual Access Medicare (HMO D-SNP)	H5117-004	Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge	Evidence of Coverage, H5117-004 - English (PDF) Evidence of Coverage, H5117-004 - Spanish (PDF)

Plan Name

CMS#

Parish

Evidence of Coverage

Wellcare Dual Access Medicare (HMO D-SNP)

H5117-004

Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge

Evidence of Coverage, H5117-004 - English (PDF)

Evidence of Coverage, H5117-004 - Spanish (PDF)

If you were enrolled in Wellcare By Allwell last year, 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 parish:

For HMO and D SNP Members:

Plan Name	CMS#	Parish	Annual Notice of Changes
Wellcare No Premium Medicare (HMO)	H5117-003	Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge	Annual Notice of Changes, H5117-003 - English, (PDF)
Wellcare Dual Access Medicare (HMO D-SNP)	H5117-004	Ascension, East Baton Rouge, Iberville, Livingston, Pointe Coupee, St. James, St Tammany parish, Tangipahoa, Washington Acadia, Lafayette, St. Landry, St. Martin parishes and West Baton Rouge parishes	Annual Notice of Changes, H5117-001-004 - English, (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 and D SNP Members:

Plan Benefit Materials

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For HMO and D SNP Members:

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 and D SNP Members:

Over-The-Counter Benefits

Plan Benefit Materials

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 and D SNP Members:

Addendum To 2023 Medicare Advantage Benefits

Over-the-Counter Catalog

2023 AHIP Flyer