Plan Benefit Materials | Allwell from Superior HealthPlan
Explore your plan and its benefits by reviewing important documents like 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.”
Wellcare By Allwell
Wellcare Assist (HMO) H5294-013
Counties: Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Karnes, Kenedy, Kleberg, Maverick, Mcmullen, Nueces, San Patricio, Starr, Webb, Willacy, Zapata
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Assist (HMO) H5294-016
Counties: Armstrong, Bailey, Borden, Briscoe, Castro, Crosby, Ector, Fisher, Floyd, Garza, Hockley, Jack, Kent, Kimble, La Salle, Lamb, Lubbock, Lynn, Martin, Mason, Mcculloch, Nolan, Palo Pinto, Potter, Randall, Shackelford, Sterling, Swisher, Terry, Throckmorton
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Giveback (HMO) H5294-019
Counties: Armstrong, Bailey, Borden, Briscoe, Castro, Crosby, Ector, Fisher, Floyd, Garza, Glasscock, Hockley, Kent, Lamb, Lubbock, Lynn, Martin, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Patriot Simple (HMO) H5294-014
Counties: Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bee, Bexar, Blanco, Borden, Briscoe, Brooks, Burnet, Caldwell, Cameron, Castro, Collin, Colorado, Comal, Crosby, Dallas, Denton, Dewitt, Duval, Ector, El Paso, Ellis, Fisher, Floyd, Garza, Glasscock, Goliad, Gonzales, Grimes, Guadalupe, Hays, Hidalgo, Hockley, Hood, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Lee, Lubbock, Lynn, Martin, Mason, Maverick, Mcculloch, Mcmullen, Medina, Milam, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, Refugio, Rockwall, San Patricio, Shackelford, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Webb, Willacy, Williamson, Wilson, Wise, Zapata, Zavala
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Simple (HMO) H5294-011
Counties: Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Karnes, Kenedy, Kleberg, Maverick, Mcmullen, Nueces, San Patricio, Starr, Webb, Willacy, Zapata
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Simple (HMO) H5294-017
Counties: Atascosa, Bandera, Dewitt, Gonzales, Kendall, Medina, Wilson
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Simple (HMO) H5294-018
Counties: Armstrong, Bailey, Borden, Briscoe, Castro, Crosby, Ector, Fisher, Floyd, Garza, Glasscock, Hockley, Kent, La Salle, Lamb, Lubbock, Lynn, Martin, Nolan, Potter, Randall, Real, Shackelford, Sterling, Swisher, Terry, Throckmorton, Uvalde, Zavala
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Wellcare Dual Access (HMO D-SNP) H5294-015
Counties: Aransas, Armstrong, Atascosa, Bailey, Bandera, Bee, Borden, Bosque, Briscoe, Brooks, Calhoun, Cameron, Carson, Castro, Cochran, Coke, Colorado, Crosby, Deaf Smith, Dewitt, Dickens, Dimmit, Donley, Duval, Ector, Ellis, Erath, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Hale, Hamilton, Hidalgo, Hill, Hockley, Hood, Hunt, Hutchinson, Irion, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Leon, Limestone, Lubbock, Lynn, Madison, Martin, Mason, Maverick, Mcculloch, Mcmullen, Medina, Mills, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, Refugio, Robertson, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Sterling, Swisher, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Wilson, Wise, Zapata, Zavala
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Dual Liberty (HMO D-SNP) H5294-010
Counties: Aransas, Atascosa, Bandera, Bee, Bosque, Brooks, Cameron, Castro, Colorado, Dimmit, Duval, Ector, Ellis, Erath, Gonzales, Grayson, Grimes, Hale, Hill, Hood, Hunt, Jim Wells, Kendall, Kleberg, La Salle, Lamb, Leon, Limestone, Lubbock, Maverick, Mcculloch, Medina, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Parker, Potter, Randall, Real, San Patricio, San Saba, Shackelford, Smith, Somervell, Starr, Uvalde, Van Zandt, Victoria, Webb, Willacy, Wilson, Wise, Zapata, Zavala
Annual Notice of Change
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty (HMO D-SNP) H5294-010 - English (PDF)
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty (HMO D-SNP) H5294-010 - Spanish (PDF)
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H5294-010 to Wellcare Dual Liberty (HMO D-SNP) H5294-010 - English (PDF)
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H5294-010 to Wellcare Dual Liberty (HMO D-SNP) H5294-010 - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Dual Liberty Sync (HMO D-SNP) H5294-021
Counties: Cameron, Duval, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, Zapata
Annual Notice of Change
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-021 - English (PDF)
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-021 - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Dual Liberty Sync (HMO D-SNP) H5294-022
Counties: Aransas, Bee, Brooks, Calhoun, Goliad, Jim Wells, Karnes, Kenedy, Kleberg, Nueces, Refugio, San Patricio, Victoria
Annual Notice of Change
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-022 - English (PDF)
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-022 - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Dual Liberty Sync (HMO D-SNP) H5294-023
Counties: Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher, Terry
Annual Notice of Change
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-023 - English (PDF)
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-023 - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Dual Liberty Sync (HMO D-SNP) H5294-024
Counties: Bosque, Colorado, Dewitt, Erath, Gillespie, Gonzales, Grimes, Hamilton, Hill, Leon, Limestone, Madison, Mills, Robertson, San Saba, Somervell
Annual Notice of Change
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-024 - English (PDF)
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-024 - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Dual Liberty Sync (HMO D-SNP) H5294-025
Counties: Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Dickens, Dimmit, Donley, Ector, Fisher, Glasscock, Irion, Jack, Kent, Kimble, La Salle, Martin, Mason, McCulloch, Mitchell, Nolan, Palo Pinto, Real, Shackelford, Sterling, Throckmorton, Uvalde, Zavala
Annual Notice of Change
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-025 - English (PDF)
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Dual Liberty Sync (HMO D-SNP) H5294-025 - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
HMO D-SNP Plans
Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-011
Counties: Dallas
Annual Notice of Change
- Annual Notice of Change: Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan) H6870-001 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-011 - English (PDF) - Coming Soon
- Annual Notice of Change: Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan) H6870-001 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-011 - Spanish (PDF) - Coming Soon
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H0174-004 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-011 - English (PDF) - Coming Soon
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H0174-004 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-011 - Spanish (PDF) - Coming Soon
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H0174-006 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-011 - English (PDF) - Coming Soon
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H0174-006 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-011 - Spanish (PDF) - Coming Soon
Summary of Benefits
- Summary of Benefits - English (PDF) - Coming Soon
- Summary of Benefits - Spanish (PDF) - Coming Soon
Evidence of Coverage
- Member Handbook - English (PDF) - Coming Soon
- Member Handbook - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-012
Counties: Hidalgo
Annual Notice of Change
- Annual Notice of Change: Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan) H6870-001 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-012 - English (PDF) - Coming Soon
- Annual Notice of Change: Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan) H6870-001 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-012 - Spanish (PDF) - Coming Soon
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-012 - English (PDF) - Coming Soon
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H5294-015 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-012 - Spanish (PDF) - Coming Soon
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H5294-010 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-012 - English (PDF) - Coming Soon
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) H5294-010 to Wellcare Superior HealthPlan Dual Align (HMO D-SNP) H0062-012 - Spanish (PDF) - Coming Soon
Summary of Benefits
- Summary of Benefits - English (PDF) - Coming Soon
- Summary of Benefits - Spanish (PDF) - Coming Soon
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Your OTC Highlight
Additional Forms
- Medicare Step Therapy Part B (PDF) - Coming Soon
- 2026 Medicare Parts A & B Premiums and Deductibles (PDF) - Coming Soon
- Member Secure Portal Guide (PDF) - Coming Soon