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Plan Benefit Materials | Allwell from Silver Summit Health
Plan Materials and Forms
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) H0351-067
Counties: Clark, Nye
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
Wellcare Simple (HMO-POS) H0351-070
Counties: Carson City, Churchill, Douglas, Lyon, Storey, Washoe
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
HMO D-SNP
Wellcare Dual Access (HMO-POS D-SNP) H0351-066
Counties: Clark, Nye
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
Wellcare Dual Access (HMO-POS D-SNP) H0351-068
Counties: Carson City, Churchill, Douglas, Lyon, Storey, Washoe
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
HMO C-SNP
Wellcare Specialty Simple (HMO-POS C-SNP) H0351-069
Counties: Clark, Nye
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
Additional Forms
- Medicare Step Therapy Part B (PDF) - Coming soon
- Covered Diabetes Testing Supplies - Coming soon
- Over-the-Counter Catalog (PDF) - Coming soon
- Over-the-Counter Catalog and Healthy Food (PDF) - Coming soon
- 2025 Original Medicare Defined Cost Share Amounts and Premiums (PDF) - Coming soon