Plan Benefit Materials |

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 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


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

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


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

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
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

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