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- Shop for Plans show Shop for Plans menu
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Pharmacy Benefits
show Pharmacy Benefits menu
-
- Find a Doctor or Pharmacy
- List of Drugs (Formulary)
- Medication Therapy Management (MTMP)
- Mail Order Service
- Specialty Pharmacy
- Coverage Determinations and Redeterminations
- Prior Authorization, Step Therapy & Quantity Limitations
- Out-of-Network Pharmacies
- Medication (Drug) Management and Safety
- Drug Transition Policy
- Pharmacy Forms
- Medicare Prescription Payment Plan
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Plan Benefit Materials | Allwell at Arizona Complete Health
Plan Benefit Materials
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
Additional Forms
Plan Benefit Materials
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) H0351-053
Counties: Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Annual Notice of Changes
- Annual Notice of Change: Wellcare No Premium (HMO) to Wellcare Simple (HMO) - English (PDF)
- Annual Notice of Change: Wellcare No Premium (HMO) to Wellcare Simple (HMO) - Spanish (PDF)
- Annual Notice of Change: Wellcare Assist (HMO) to Wellcare Simple (HMO)-English (PDF)
- Annual Notice of Change: Wellcare Assist (HMO) to Wellcare Simple (HMO) - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
Wellcare Giveback (HMO) H0351-054
Counties: Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Simple (HMO) H0351-063
Counties: Maricopa, Pima, Pinal
Annual Notice of Changes
- Annual Notice of Change: Wellcare No Premium (HMO) to Wellcare Simple (HMO) - English (PDF)
- Annual Notice of Change: Wellcare No Premium (HMO) to Wellcare Simple (HMO) - Spanish (PDF)
- Annual Notice of Change: Wellcare Assist (HMO) to Wellcare Simple (HMO) - English (PDF)
- Annual Notice of Change: Wellcare Assist (HMO) to Wellcare Simple (HMO) - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
Wellcare Giveback (HMO) H0351-064
Counties: Maricopa, Pima, Pinal
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Simple Value (HMO) H0351-065
Counties: Maricopa, Pima, Pinal
HMO C-SNP
Wellcare Specialty Simple (HMO C-SNP) H0351-038
Counties: Maricopa, Pima, Pinal
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Specialty Simple (HMO C-SNP) H0351-057
Counties: Cochise, Mohave, Santa Cruz, Yavapai, Yuma
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
HMO D-SNP
Wellcare Dual Liberty (HMO D-SNP) H5590-008
Counties: Apache, Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Maricopa, Mohave, Navajo, Pima, Pinal, Santa Cruz, Yavapai, Yuma
Annual Notice of Changes
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H5590-008 to Wellcare Dual Liberty (HMO D-SNP) H5590-008 - English (PDF)
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H5590-008 to Wellcare Dual Liberty (HMO D-SNP) H5590-008 - Spanish (PDF)
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H5590-009 to Wellcare Dual Liberty (HMO D-SNP) H5590-008 - English (PDF)
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H5590-009 to Wellcare Dual Liberty (HMO D-SNP) H5590-008 - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
Additional Forms
If you have questions please, contact Member Services.
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