Plan Benefit Materials | Allwell from Superior HealthPlan

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.

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 NameCMS #CountyEvidence of Coverage
Wellcare Patriot No Premium (HMO)H5294-014Aransas, Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bee, Bexar, Blanco, Borden, Bosque, Briscoe, Brooks, Burnet, Caldwell, Calhoun, Cameron, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, Hood, Hunt, Irion, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Lee, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, McMullen, Medina, Milam, Mills, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Wise, Zapata, Zavala

 

Wellcare No Premium (HMO)H5294-011Aransas, Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, La Salle, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Webb, Willacy, Zapata
Wellcare Giveback (HMO)H5294-012Aransas, Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, La Salle, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Webb, Willacy, Zapata
Wellcare Complement Assist (HMO)H5294-013Aransas, Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, La Salle, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Webb, Willacy, Zapata

 

Wellcare Complement Assist (HMO)H5294-016Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bexar, Blanco, Borden, Bosque, Briscoe, Burnet, Caldwell, Calhoun, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hill, Hockley, Hood, Hunt, Irion, Jack, Karnes, Kendall, Kent, Kimble, Lamb, Lee, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, Medina, Milam, Mills, Mitchell, Navarro, Nolan, Palo Pinto, Parker, Potter, Randall, Real, Rockwall, San Saba, Shackelford, Smith, Somervell, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Williamson, Wilson, Wise, Zavala

 

Wellcare No Premium (HMO)H5294-017Atascosa, Bandera, Bexar, Comal, DeWitt, Dimmit, Gonzales, Guadalupe, Karnes, Kendall, Maverick, Medina, Real, Uvalde, Wilson, Zavala
Wellcare No Premium (HMO)H5294-018Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Ector, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton
 

 

Wellcare Giveback (HMO)H5294-019Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Ector, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton
Wellcare No Premium (HMO)H5294-020Potter, Randall

For HMO D-SNP Members:

Plan NameCMS #CountyEvidence of Coverage
Wellcare Dual Liberty Nurture (HMO D-SNP)H5294-010Aransas, Armstrong, Atascosa, Bailey, Bandera, Bee, Bexar, Borden, Bosque, Briscoe, Brooks, Calhoun, Cameron, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hidalgo, Hill, Hockley, Hood, Hunt, Irion, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, McMullen, Medina, Mills, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Wilson, Wise, Zapata, Zavala
 
Wellcare Dual Access Harmony (HMO D-SNP)H5294-015Aransas, Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bee, Bexar, Blanco, Borden, Bosque, Briscoe, Brooks, Burnet, Caldwell, Calhoun, Cameron, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, Hood, Hunt, Irion, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Lee, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, McMullen, Medina, Milam, Mills, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Wise, Zapata, Zavala

 

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 NameCMS #CountyAnnual Notice of Changes
Wellcare Patriot No Premium (HMO)H5294-014Aransas, Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bee, Bexar, Blanco, Borden, Bosque, Briscoe, Brooks, Burnet, Caldwell, Calhoun, Cameron, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, Hood, Hunt, Irion, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Lee, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, McMullen, Medina, Milam, Mills, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Wise, Zapata, Zavala
 
Wellcare No Premium (HMO)H5294-011Aransas, Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, La Salle, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Webb, Willacy, Zapata
Wellcare Giveback (HMO)H5294-012Aransas, Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, La Salle, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Webb, Willacy, Zapata
Wellcare Complement Assist (HMO)H5294-013Aransas, Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, La Salle, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Webb, Willacy, Zapata
Wellcare Complement Assist (HMO)H5294-016Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bexar, Blanco, Borden, Bosque, Briscoe, Burnet, Caldwell, Calhoun, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hill, Hockley, Hood, Hunt, Irion, Jack, Karnes, Kendall, Kent, Kimble, Lamb, Lee, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, Medina, Milam, Mills, Mitchell, Navarro, Nolan, Palo Pinto, Parker, Potter, Randall, Real, Rockwall, San Saba, Shackelford, Smith, Somervell, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Williamson, Wilson, Wise, Zavala
Wellcare No Premium (HMO)H5294-017Atascosa, Bandera, Bexar, Comal, DeWitt, Dimmit, Gonzales, Guadalupe, Karnes, Kendall, Maverick, Medina, Real, Uvalde, Wilson, Zavala
Wellcare No Premium (HMO)H5294-018Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Ector, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton
Wellcare Giveback (HMO)H5294-019Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Ector, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton
Wellcare No Premium (HMO)H5294-020Potter, Randall

For HMO D-SNP Members:

Plan NameCMS #CountyAnnual Notice of Changes
Wellcare Dual Liberty Nurture (HMO D-SNP)H5294-010Aransas, Armstrong, Atascosa, Bailey, Bandera, Bee, Bexar, Borden, Bosque, Briscoe, Brooks, Calhoun, Cameron, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hidalgo, Hill, Hockley, Hood, Hunt, Irion, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, McMullen, Medina, Mills, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Wilson, Wise, Zapata, Zavala
Wellcare Dual Access Harmony (HMO D-SNP)H5294-015 Aransas, Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bee, Bexar, Blanco, Borden, Bosque, Briscoe, Brooks, Burnet, Caldwell, Calhoun, Cameron, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, Hood, Hunt, Irion, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Lee, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, McMullen, Medina, Milam, Mills, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Wise, Zapata, Zavala