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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.
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 county:
For HMO Members:
PLAN NAME | CMS # | County | Summary of Benefits |
---|---|---|---|
Wellcare No Premium (HMO) | H6446-001 | Clark, Nye | |
Wellcare No Premium (HMO) | H6446-010 | Carson City, Churchill, Douglas, Lyon, Storey, Washoe |
For HMO D-SNP Members:
Plan Name | CMS # | County | Summary of Benefits |
---|---|---|---|
Wellcare Dual Access (HMO D-SNP) | H6446-014 | Clark, Nye | |
Wellcare Dual Access (HMO D-SNP) | H6446-016 | Carson City, Churchill, Douglas, Lyon, Storey, Washoe |
For HMO C-SNP Members:
Plan Name | CMS # | County | Summary of Benefits |
---|---|---|---|
Wellcare Specialty No Premium (HMO C-SNP) | H6446-017 | Clark, Nye |
For PPO Members:
Plan Name | CMS # | County | Summary of Benefits |
---|---|---|---|
Wellcare No Premium Open (PPO) | H8458-003 | Carson City, Clark, Churchill, Douglas, Lyon, Storey, Washoe |
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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 | Evidence of Changes |
---|---|---|---|
Wellcare No Premium (HMO) | H6446-001 | Clark, Nye |
|
Wellcare No Premium (HMO) | H6446-010 | Carson City, Churchill, Douglas, Lyon, Storey, Washoe |
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For HMO D-SNP Members:
Plan Name | CMS # | County | Evidence of Changes |
---|---|---|---|
Wellcare Dual Access (HMO D-SNP) | H6446-014 | Clark, Nye |
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Wellcare Dual Access (HMO D-SNP) | H6446-016 | Carson City, Churchill, Douglas, Lyon, Storey, Washoe |
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For HMO C-SNP Members:
Plan Name | CMS # | County | Evidence of Changes |
---|---|---|---|
Wellcare Specialty No Premium (HMO C-SNP) | H6446-017 | Clark, Nye |
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For PPO Members:
Plan Name | CMS # | County | Evidence of Changes |
---|---|---|---|
Wellcare No Premium Open (PPO) | H8458-003 | Carson City, Clark, Churchill, Douglas, Lyon, Storey, Washoe |
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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 |
---|---|---|---|
Wellcare No Premium (HMO) | H6446-001 | Clark, Nye |
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Wellcare Giveback (HMO) to Wellcare No Premium (HMO) | H6446-003 to H6446-001 | Clark, Nye |
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Wellcare Assist (HMO) to Wellcare No Premium (HMO) | H6446-011 to H6446-001 | Clark, Nye | |
Wellcare Giveback (HMO) to Wellcare No Premium (HMO) | H6446-005 to H6446-010 | Carson City, Churchill, Douglas, Lyon, Storey, Washoe |
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Wellcare No Premium (HMO) | H6446-010 | Carson City, Churchill, Douglas, Lyon, Storey, Washoe |
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Wellcare Assist (HMO) to Wellcare No Premium (HMO) | H6446-013 to H6446-010 | Carson City, Churchill, Douglas, Lyon, Storey, Washoe |
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For HMO D-SNP and C-SNP Members:
Plan Name | CMS # | County | Annual Notice of Changes |
---|---|---|---|
Wellcare Dual Access (HMO D-SNP) | H6446-014 | Clark, Nye |
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Wellcare Dual Access (HMO D-SNP) | H6446-016 | Carson City, Churchill, Douglas, Lyon, Storey, Washoe |
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Wellcare Specialty No Premium (HMO C-SNP) | H6446-017 | Clark, Nye |
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For PPO Members:
Plan Name | CMS # | County | Annual Notice of Changes |
---|---|---|---|
Wellcare No Premium Open (PPO) | H8458-003 | Carson City, Churchill, Clark, Douglas, Lyon, Nye, Storey, Washoe |
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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 |
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