Plan Benefit Materials | Allwell at Arizona Complete 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.

For HMO Members

Plans CMS# County Summary of Benefits
Wellcare No Premium (HMO) H0351 - 052
  • Maricopa, Pima, Pinal, Yavapai
Wellcare No Premium (HMO) H0351 - 053
  • Cochise, Mohave, Santa Cruz, Yuma
Wellcare Giveback (HMO) H0351 - 054
  • Cochise, Mohave, Santa Cruz, Yuma
Wellcare Assist (HMO) H0351 - 055
  • Maricopa, Pima, Pinal, Yavapai
Wellcare Giveback (HMO) H0351 - 056
  • Maricopa, Pima, Pinal, Yavapai
Wellcare No Premium Essentials (HMO) H5590-0005
  • Maricopa and Pinal
Wellcare Assist (HMO) H5590 - 007
  • Cochise, Mohave, Santa Cruz, Yuma

For HMO D-SNP Members

Plans CMS# County Summary of Benefits
Wellcare Dual Liberty (HMO D-SNP) H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yuma
Wellcare Dual Liberty (HMO D-SNP) H5590 - 009
  • Apache, Coconino, Mohave, Navajo, Yavapai
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 038
  • Maricopa, Pima and Pinal
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 057
  • Cochise, Mohave, Santa Cruz, Yavapai, Yuma


For HMO Members

Plans CMS# County Evidence of Coverage
Wellcare No Premium (HMO) H0351 - 052
  • Maricopa, Pima, Pinal, Yavapai
Wellcare No Premium (HMO) H0351 - 053
  • Cochise, Mohave, Santa Cruz, Yuma
Wellcare Giveback (HMO) H0351 - 054
  • Cochise, Mohave, Santa Cruz, Yuma
Wellcare Assist (HMO) H0351 - 055
  • Maricopa, Pima, Pinal, Yavapai
Wellcare Giveback (HMO) H0351 - 056
  • Maricopa, Pima, Pinal, Yavapai
Wellcare No Premium Essentials (HMO) H5590-0005
  • Maricopa and Pinal
Wellcare Assist (HMO) H5590 - 007
  • Cochise, Mohave, Santa Cruz, Yuma


For HMO D-SNP Members

Plans  CMS# County Evidence of Coverage
Wellcare Dual Liberty (HMO D-SNP) H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yuma
Wellcare Dual Liberty (HMO D-SNP) H5590 - 009
  • Apache, Coconino, Mohave, Navajo, Yavapai
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 038
  • Maricopa, Pima and Pinal
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 057
  • Cochise, Mohave, Santa Cruz, Yavapai, Yuma


For PPO Members

Plans  CMS# County Evidence of Coverage
Wellcare No Premium Open (PPO) H8553 - 001
  • Maricopa, Pima
Wellcare Patriot Giveback Open (PPO) H8553 - 002
  • Maricopa, Pima
Wellcare No Premium Rx Plus Open (PPO) H8553 - 003
  • Maricopa, Pima

 


For HMO Members

Plans CMS# County Annual Notice of Changes
Wellcare No Premium (HMO) H0351-052
  • Maricopa, Pima, Pinal, Yavapai
WellCare Value (HMO) to WellCare No Premium (HMO) H6439-002 to H0351-052
  • Maricopa, Pima, Pinal, Yavapai
Wellcare No Premium (HMO) H0351 - 053
  • Cochise, Mohave, Santa Cruz, Yuma
Wellcare Giveback (HMO) H0351 - 054
  • Cochise, Mohave, Santa Cruz, Yuma
WellCare Compass (HMO) to Wellcare Assist (HMO) H6439-003 - H0351-055
  • Maricopa, Pima, Pinal, Yavapai
WellCare Dividend (HMO) to Wellcare Giveback (HMO) H6439-004 - H0351-056
  • Maricopa, Pima, Pinal, Yavapai
Wellcare No Premium Essentials (HMO) H5590-0005
  • Maricopa and Pinal
Wellcare Assist (HMO) H5590 - 007
  • Cochise, Mohave, Santa Cruz, Yuma
Allwell Medicare (HMO) to Wellcare Assist (HMO) H5590-004 - H5590-007
  • Cochise, Mohave, Santa Cruz, Yuma


For HMO D-SNP Members

Plans  CMS# County Annual Notice of Change
Wellcare Dual Liberty (HMO D-SNP) H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yuma
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 038
  • Maricopa, Pima and Pinal