Plan Benefit Materials | Allwell from Silver Summit Health

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 county:

For HMO Members:

Plan Name CMS # County Summary of Benefits
Wellcare No Premium P3 (HMO)  H6446- 001

Clark, Nye

Wellcare Giveback P3 (HMO) H6446- 003

Clark, Nye

Wellcare Giveback USHS (HMO) H6446- 004

Clark, Nye

Wellcare Giveback (HMO) H6446- 005 Carson City, Lyon, Washoe

 

Wellcare No Premium USHS (HMO) H6446- 009

Clark, Nye

Wellcare No Premium (HMO) H6446- 010 Carson City, Lyon, Washoe
Wellcare Assist P3 (HMO) H6446- 011

Clark, Nye

Wellcare Assist USHS (HMO) H6446- 012

Clark, Nye

Wellcare Assist (HMO) H6446- 013 Carson City, Lyon, Washoe

For HMO SNP Members:  

Plan Name CMS # County  Summary of Benefits
Wellcare Dual Access P3 (HMO D-SNP) H6446- 014

Clark, Nye

Wellcare Dual Access USHS (HMO D-SNP) H6446- 015

Clark, Nye

Wellcare Dual Access (HMO D-SNP) H6446- 016 Carson City, Lyon, Washoe
Wellcare Specialty No Premium P3 (HMO C-SNP) H6446- 017 Clark
Wellcare Specialty No Premium USHS (HMO C-SNP) H6446- 018 Clark

For PPO Members:  

Plan Name CMS # County  Summary of Benefits
Wellcare No Premium Open (PPO) H8458-001

Clark

Wellcare Patriot Giveback Open (PPO) H8458-002 Clark
Wellcare No Premium Open (PPO) H8458-003 Lyon and Washoe


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 (EOC)
Wellcare No Premium P3 (HMO) H6446- 001

Clark, Nye

Wellcare Giveback P3 (HMO) H6446- 003

Clark, Nye

Wellcare Giveback USHS (HMO) H6446- 004

Clark, Nye

Wellcare Giveback (HMO) H6446- 005 Carson City, Lyon, Washoe

 

Wellcare No Premium USHS (HMO) H6446- 009

Clark, Nye

Wellcare No Premium (HMO)  H6446- 010 Carson City, Lyon, Washoe
Wellcare Assist P3 (HMO) H6446- 011

Clark, Nye

Wellcare Assist USHS (HMO) H6446- 012

Clark, Nye

Wellcare Assist (HMO) H6446- 013 Carson City, Lyon, Washoe

For HMO D-SNP & HMO C-SNP Members:  

Plan Name CMS # County  Evidence of Coverage (EOC)
Wellcare Dual Access P3 (HMO D-SNP) H6446- 014

Clark, Nye

Wellcare Dual Access USHS (HMO D-SNP) H6446- 015

Clark, Nye

Wellcare Dual Access (HMO D-SNP)  H6446- 016 Carson City, Lyon, Washoe
Wellcare Specialty No Premium P3 (HMO C-SNP) H6446- 017 Clark
Wellcare Specialty No Premium USHS (HMO C-SNP) H6446- 018 Clark

For PPO Members:  

Plan Name CMS # County  Evidence of Coverage
Wellcare No Premium Open (PPO) H8458-001

Clark

Wellcare Patriot Giveback Open (PPO) H8458-002 Clark
Wellcare No Premium Open (PPO) H8458-003 Lyon and Washoe

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 county:

For HMO Members:

Plan Name CMS # County Annual Notice of Changes (ANOC)
Wellcare No Premium P3 (HMO) H6446-001

Clark, Nye

Wellcare Giveback P3 (HMO) H6446-003

 

Wellcare Giveback USHS (HMO) H6446-004

 

Wellcare Giveback (HMO) H6446-005

 

Wellcare No Premium USHS (HMO) H6446-009

 

Wellcare No Premium (HMO) H6446-010

 

Wellcare Assist P3 (HMO) H6446-011

 

Wellcare Assist USHS (HMO) H6446-012

 

Wellcare Assist (HMO) H6446-013

 

For HMO D-SNP Members:

Plan Name CMS # County Annual Notice of Changes (ANOC)
Wellcare Dual Access P3 (HMO D-SNP) H6446-014

 

Wellcare Dual Access USHS (HMO D-SNP) H6446-015

 

Wellcare Dual Access (HMO D-SNP) H6446-016