Plan Benefit Materials

CMS #	County	Summary of Benefits
H6446-001	Clark, Nye	Summary of Benefits, H6446-001 - English (PDF) Summary of Benefits, H6446-001 - Spanish (PDF)
H6446-010	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Summary of Benefits, H6446-010 - English (PDF) Summary of Benefits, H6446-010 - Spanish (PDF)

Plan Name	CMS #	County	Summary of Benefits
Wellcare No Premium Open (PPO)	H8458-003	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Summary of Benefits, H8458-003 - English (PDF) Summary of Benefits, H8458-003 - Spanish (PDF)

Plan Name	CMS #	County	Evidence of Changes
Wellcare Dual Access (HMO D-SNP)	H6446-014	Clark, Nye	Evidence of Changes, H6446-014 - English (PDF) Evidence of Changes, H6446-014 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare Dual Access (HMO D-SNP)	H6446-016	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Evidence of Changes, H6446-016 - English (PDF) Evidence of Changes, H6446-016 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name	CMS #	County	Evidence of Changes
Wellcare Specialty No Premium (HMO C-SNP)	H6446-017	Clark, Nye	Evidence of Changes, H6446-017 - English (PDF) Evidence of Changes, H6446-017 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name	CMS #	County	Evidence of Changes
Wellcare No Premium Open (PPO)	H8458-003	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Evidence of Changes, H8458-003 - English (PDF) Evidence of Changes, H8458-003 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare No Premium Open (PPO)	H8458-003	Carson City, Churchill, Clark, Douglas, Lyon, Nye, Storey, Washoe	Annual Notice of Changes, H8458-003 - English (PDF) Annual Notice of Changes, H8458-003 - Spanish (PDF)
Wellcare No Premium Open (PPO) to Wellcare No Premium Open (PPO)	H8458-001 to H8458-003	Carson City, Churchill, Clark, Douglas, Lyon, Nye, Storey, Washoe	Annual Notice of Changes, H8458-001 to H8458-003 - English (PDF) Annual Notice of Changes, H8458-001 to H8458-003 - Spanish (PDF)

This booklet gives you a summary of costs and coverage in your plan.

Please select the document for your plan and county:

**Refer to Addendum to 2023 Medicare Advantage Benefits for additional information**

For HMO Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare No Premium (HMO)	H6446-001	Clark, Nye	Summary of Benefits, H6446-001 - English (PDF) Summary of Benefits, H6446-001 - Spanish (PDF)
Wellcare Giveback (HMO)	H6446-003	Clark, Nye	Summary of Benefits, H6446-003 - English (PDF) Summary of Benefits, H6446-003 - Spanish (PDF)
Wellcare Giveback (HMO)	H6446-005	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Summary of Benefits, H6446-005 - English (PDF) Summary of Benefits, H6446-005 - Spanish (PDF)
Wellcare No Premium (HMO)	H6446-010	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Summary of Benefits, H6446-010 - English (PDF) Summary of Benefits, H6446-010 - Spanish (PDF)
Wellcare Assist (HMO)	H6446-011	Clark, Nye	Summary of Benefits, H6446-011 - English (PDF) Summary of Benefits, H6446-011 - Spanish (PDF)
Wellcare Assist (HMO)	H6446-013	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Summary of Benefits, H6446-013 - English (PDF) Summary of Benefits, H6446-013 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare Dual Access (HMO D-SNP)	H6446-014	Clark, Nye	Summary of Benefits, H6446-014 - English (PDF) Summary of Benefits, H6446-014 - Spanish (PDF)
Wellcare Dual Access (HMO D-SNP)	H6446-016	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Summary of Benefits, H6446-016 - English (PDF) Summary of Benefits, H6446-016 - Spanish (PDF)

For HMO C-SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare Specialty No Premium (HMO C-SNP)	H6446-017	Clark, Nye	Summary of Benefits, H6446-017 - English (PDF) Summary of Benefits, H6446-017 - Spanish (PDF)

For PPO Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare No Premium Open (PPO)	H8458-001	Clark, Nye	Summary of Benefits, H8458-001 - English (PDF) Summary of Benefits, H8458-001 - Spanish (PDF)
Wellcare Patriot Giveback Open (PPO)	H8458-002	Clark, Nye	Summary of Benefits, H8458-002 - English (PDF) Summary of Benefits, H8458-002 - Spanish (PDF)
Wellcare No Premium Open (PPO)	H8458-003	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Summary of Benefits, H8458-003 - English (PDF) Summary of Benefits, H8458-003 - Spanish (PDF)

This booklet gives you a summary of costs and coverage in your plan.

Please select the document for your plan and county:

**Refer to Addendum to 2023 Medicare Advantage Benefits for additional information**

For HMO Members:

Plan Name	CMS #	County	Evidence of Changes
Wellcare No Premium (HMO)	H6446-001	Clark, Nye	Evidence of Changes, H6446-001 - English (PDF) Evidence of Changes, H6446-001 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare Giveback (HMO)	H6446-003	Clark, Nye	Evidence of Changes, H6446-003 - English (PDF) Evidence of Changes, H6446-003 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare Giveback (HMO)	H6446-005	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Evidence of Changes, H6446-005 - English (PDF) Evidence of Changes, H6446-005 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare No Premium (HMO)	H6446-010	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Evidence of Changes, H6446-010 - English (PDF) Evidence of Changes, H6446-010 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare Assist (HMO)	H6446-011	Clark, Nye	Evidence of Changes, H6446-011 - English (PDF) Evidence of Changes, H6446-011 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare Assist (HMO)	H6446-013	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Evidence of Changes, H6446-013 - English (PDF) Evidence of Changes, H6446-013 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Evidence of Changes
Wellcare Dual Access (HMO D-SNP)	H6446-014	Clark, Nye	Evidence of Changes, H6446-014 - English (PDF) Evidence of Changes, H6446-014 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare Dual Access (HMO D-SNP)	H6446-016	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Evidence of Changes, H6446-016 - English (PDF) Evidence of Changes, H6446-016 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name

CMS #

County

Evidence of Changes

Wellcare Dual Access (HMO D-SNP)

H6446-014

Clark, Nye

Evidence of Changes, H6446-014 - English (PDF)

Evidence of Changes, H6446-014 - Spanish (PDF)

Wellcare Dual Access (HMO D-SNP)

H6446-016

Carson City, Churchill, Douglas, Lyon, Storey, Washoe

Evidence of Changes, H6446-016 - English (PDF)

Evidence of Changes, H6446-016 - Spanish (PDF)

For HMO C-SNP Members:

Plan Name	CMS #	County	Evidence of Changes
Wellcare Specialty No Premium (HMO C-SNP)	H6446-017	Clark, Nye	Evidence of Changes, H6446-017 - English (PDF) Evidence of Changes, H6446-017 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name

CMS #

County

Evidence of Changes

Wellcare Specialty No Premium (HMO C-SNP)

H6446-017

Clark, Nye

Evidence of Changes, H6446-017 - English (PDF)

Evidence of Changes, H6446-017 - Spanish (PDF)

For PPO Members:

Plan Name	CMS #	County	Evidence of Changes
Wellcare No Premium Open (PPO)	H8458-001	Clark, Nye	Evidence of Changes, H8458-001 - English (PDF) Evidence of Changes, H8458-001 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare Patriot Giveback Open (PPO)	H8458-002	Clark, Nye	Evidence of Changes, H8458-002 - English (PDF) Evidence of Changes, H8458-002 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Wellcare No Premium Open (PPO)	H8458-003	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Evidence of Changes, H8458-003 - English (PDF) Evidence of Changes, H8458-003 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name

CMS #

County

Evidence of Changes

Wellcare No Premium Open (PPO)

H8458-001

Clark, Nye

Evidence of Changes, H8458-001 - English (PDF)

Evidence of Changes, H8458-001 - Spanish (PDF)

Dental Benefit Details - English (PDF)

Dental Benefit Details - Spanish (PDF)

Wellcare Patriot Giveback Open (PPO)

H8458-002

Clark, Nye

Evidence of Changes, H8458-002 - English (PDF)

Evidence of Changes, H8458-002 - Spanish (PDF)

Dental Benefit Details - English (PDF)

Dental Benefit Details - Spanish (PDF)

Wellcare No Premium Open (PPO)

H8458-003

Carson City, Churchill, Douglas, Lyon, Storey, Washoe

Evidence of Changes, H8458-003 - English (PDF)

Evidence of Changes, H8458-003 - Spanish (PDF)

Dental Benefit Details - English (PDF)

Dental Benefit Details - Spanish (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:

**Refer to Addendum to 2023 Medicare Advantage Benefits for additional information**

For HMO Members:

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare No Premium (HMO)	H6446-001	Clark, Nye	Annual Notice of Changes, H6446-001 to H6446-001 - English (PDF) Annual Notice of Changes, H6446-001- Spanish (PDF)
Wellcare No Premium USHS (HMO) to Wellcare No Premium (HMO)	H6446-009 to H6446-001	Clark, Nye	Annual Notice of Changes, H6446-009 to H6446-001 - English (PDF) Annual Notice of Changes, H6446-009 to H6446-001 - Spanish (PDF)
Wellcare Giveback (HMO)	H6446-003	Clark, Nye	Annual Notice of Changes, H6446-003 English (PDF) Annual Notice of Changes, H6446-003 Spanish (PDF)
Wellcare Giveback USHS (HMO) to Wellcare Giveback (HMO)	H6446-004 to H6446-003	Clark, Nye	Annual Notice of Changes, H6446-004 to H6446-003 - English (PDF) Annual Notice of Changes, H6446-004 to H6446-003 - Spanish (PDF)
Wellcare Giveback (HMO)	H6446-005	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Annual Notice of Changes, H6446-005 to H6446-005 - English (PDF) Annual Notice of Changes, H6446-005 Spanish (PDF)
Wellcare No Premium (HMO)	H6446-010	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Annual Notice of Changes, H6446-010 to H6446-010 - English (PDF) Annual Notice of Changes, H6446-010 to H6446-010 - Spanish (PDF)
Wellcare Assist (HMO)	H6446-011	Clark, Nye	Annual Notice of Changes, H6446-011 to H6446-011 - English (PDF) Annual Notice of Changes, H6446-011 - Spanish (PDF)
Wellcare Assist USHS (HMO) to Wellcare Assist (HMO)	H6446-012 to H6446-011	Clark, Nye	Annual Notice of Changes, H6446-012 to H6446-011 - English (PDF) Annual Notice of Changes, H6446-012 to H6446-011 - Spanish (PDF)
Wellcare Assist (HMO)	H6446-013	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Annual Notice of Changes, H6446-013 to H6446-013 - English (PDF) Annual Notice of Changes, H6446-013 - Spanish (PDF)
Wellcare Specialty No Premium (HMO C-SNP)	H6446-017	Clark, Nye	Annual Notice of Changes, H6446-017 to H6446-017 - English (PDF) Annual Notice of Changes, H6446-017 - Spanish (PDF)
Wellcare Specialty No Premium USHS (HMO C-SNP) to Wellcare Specialty No Premium (HMO C-SNP)	H6446-018 to H6446-017	Clark, Nye	Annual Notice of Changes, H6446-018 to H6446-017 - English (PDF) Annual Notice of Changes, H6446-018 to H6446-017 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare Dual Access (HMO D-SNP)	H6446-014	Clark, Nye	Annual Notice of Changes, H6446-014 to H6446-014 - English (PDF) Annual Notice of Changes, H6446-014 Spanish (PDF)
Wellcare Dual Access USHS (HMO D-SNP) to Wellcare Dual Access (HMO D-SNP)	H6446-015 to H6446-014	Clark, Nye	Annual Notice of Changes, H6446-015 to H6446-014 - English (PDF) Annual Notice of Changes, H6446-015 to H6446-014 - Spanish (PDF)
Wellcare Dual Access (HMO D-SNP)	H6446-016	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Annual Notice of Changes, H6446-016 to H6446-016 - English (PDF) Annual Notice of Changes, H6446-016 to H6446-016 - Spanish (PDF)

For PPO Members:

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare No Premium Open (PPO)	H8458-001	Clark, Nye	Annual Notice of Changes, H8458-001 to H8458-001 - English (PDF) Annual Notice of Changes, H8458-001 to H8458-001 - Spanish (PDF)
Wellcare Patriot Giveback Open (PPO)	H8458-002	Clark, Nye	Annual Notice of Changes, H8458-002 to H8458-002 - English (PDF) Annual Notice of Changes, H8458-002 to H8458-002 - Spanish (PDF)
Wellcare No Premium Open (PPO)	H8458-003	Carson City, Churchill, Douglas, Lyon, Storey, Washoe	Annual Notice of Changes, H8458-003 to H8458-003 - English (PDF) Annual Notice of Changes, H8458-003 to H8458-003 - Spanish (PDF)

Medicare Step Therapy Part B (PDF)

This document is an addendum to the 2023 Evidence of Coverage (EOC), Annual Notice of Change (ANOC) and Summary of Benefits (SB) for the plan(s) listed below. It describes the member cost sharing protections provided under the Inflation Reduction Act (IRA) for certain Part B drugs.

Addendum to 2023 Medicare Advantage Benefits - English (PDF)
Addendum to 2023 Medicare Advantage Benefits - Spanish (PDF)
- H6446-001 Wellcare No Premium (HMO)
- H6446-003 Wellcare Giveback (HMO)
- H6446-005 Wellcare Giveback (HMO)
- H6446-010 Wellcare No Premium (HMO)
- H6446-011 Wellcare Assist (HMO)
- H6446-013 Wellcare Assist (HMO)
- H6446-017 Wellcare Specialty No Premium (HMO C-SNP)
- H8458-001 Wellcare No Premium Open (PPO)
- H8458-002 Wellcare Patriot Giveback Open (PPO)
- H8458-003 Wellcare No Premium Open (PPO)

Mid-Year Change Notification - English (PDF)
Mid-Year Change Notification - Spanish (PDF)
- H8458-001 Wellcare No Premium Open(PPO)
- H8458-002 Wellcare Patriot Giveback Open (PPO)
- H8458-003 Wellcare No Premium Open (PPO)

AHIP Flyer (PDF)

Plan Benefit Materials | Allwell from Silver Summit Health

Plan Materials and Forms

For HMO D-SNP Members:

For HMO C-SNP Members:

For PPO Members:

For HMO D-SNP Members:

For HMO C-SNP Members:

For PPO Members:

For HMO D-SNP and C-SNP Members:

For PPO Members:

For HMO Members:

For HMO D-SNP Members:

For HMO C-SNP Members:

For PPO Members:

For HMO Members:

For HMO D-SNP Members:

For HMO C-SNP Members:

For PPO Members:

For HMO Members:

For HMO D-SNP Members:

For PPO Members:

Plan Benefit Materials | Allwell from Silver Summit Health

Plan Materials and Forms

Summary of Benefits (SB)

For HMO D-SNP Members:

For HMO C-SNP Members:

For PPO Members:

Evidence Of Coverage (EOC)

For HMO D-SNP Members:

For HMO C-SNP Members:

For PPO Members:

Annual Notice of Changes (ANOC)

For HMO D-SNP and C-SNP Members:

For PPO Members:

Step Therapy Part B

Over-the Counter Catalog and Healthy Food

Plan Benefit Materials

Summary of Benefits (SB)

For HMO Members:

For HMO D-SNP Members:

For HMO C-SNP Members:

For PPO Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D-SNP Members:

For HMO C-SNP Members:

For PPO Members:

Annual Notice of Changes (ANOC)

For HMO Members:

For HMO D-SNP Members:

For PPO Members:

Step Therapy Part B

Addendum To 2023 Medicare Advantage Benefits

Mid-Year Change Notification

Over-the-Counter Catalog

2023 AHIP Flyer