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.

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

PlansCMS#CountySummary of Benefits
Wellcare No Premium (HMO)H0351 - 053
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare Giveback (HMO)H0351 - 054
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare No Premium (HMO)H0351 - 063
  • Maricopa, Pima, Pinal
Wellcare Assist (HMO)H0351 - 061
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare Assist (HMO)H0351 - 062
  • Maricopa, Pima, Pinal
Wellcare Giveback (HMO)H0351 - 064
  • Maricopa, Pima, Pinal

 

For HMO D-SNP and C-SNP Members

Plans CMS#CountySummary 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

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

PlansCMS#CountyEvidence of Coverage
Wellcare No Premium (HMO)H0351 - 053
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare Giveback (HMO)H0351 - 054
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare No Premium (HMO)H0351 - 063
  • Maricopa, Pima, Pinal
Wellcare Assist (HMO)H0351 - 061
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare Assist (HMO)H0351 - 062
  • Maricopa, Pima, Pinal
Wellcare Giveback (HMO)H0351 - 064
  • Maricopa, Pima, Pinal


For HMO D-SNP and C-SNP Members

Plans CMS#CountyEvidence of Coverage
Wellcare Dual Liberty (HMO D-SNP)H5590 - 008
  • Cochise, Gila, Graham, 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, Pinal
Wellcare Specialty No Premium (HMO C-SNP)H0351 - 057
  • Cochise, Mohave, Santa Cruz, Yavapai, Yuma

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

PlansCMS#CountyAnnual Notice of Changes
Wellcare No Premium (HMO)H0351 - 053
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yuma
Wellcare Giveback (HMO)H0351 - 054
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yuma
Wellcare Giveback (HMO)H0351-060-002 to H0351-054
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yuma
Wellcare No Premium (HMO)H0351-058-002 to H0351-053
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare No Premium (HMO)H0351-058-001 to H0351-063
  • Maricopa, Pima, Pinal
Wellcare No Premium (HMO)H0351-059-001 to H0351-063
  • Maricopa, Pima, Pinal
Wellcare Assist (HMO)

 

 

H0351-061


 

  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare Assist (HMO)H0351-059-002 to H0351-061
  • Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Santa Cruz, Yavapai, Yuma
Wellcare Giveback (HMO)H0351-060-001 to H0351-064
  • Maricopa, Pima, Pinal


For HMO D-SNP and C-SNP Members

Plans CMS#CountyAnnual Notice of Change
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)H0351-059-001 to 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, Pinal
Wellcare Specialty No Premium (HMO C-SNP)H0351 - 057
  • Cochise, Mohave, Santa Cruz, Yavapai, Yuma