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- Shop for Plans show Shop for Plans menu
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Pharmacy Benefits
show Pharmacy Benefits menu
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- 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
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Plan Benefit Materials | Allwell from Superior HealthPlan
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) H5294-011
Counties: Aransas, Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, La Salle, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Webb, Willacy, Zapata
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Assist (HMO) H5294-013
Counties: Aransas, Bee, Brooks, Cameron, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, La Salle, McMullen, Nueces, Refugio, San Patricio, Starr, Victoria, Webb, Willacy, Zapata
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Patriot Simple (HMO) H5294-014
Counties: Aransas, Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bee, Bexar, Blanco, Borden, Bosque, Briscoe, Brooks, Burnet, Caldwell, Calhoun, Cameron, Castro, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Duval, Ector, El Paso, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hamilton, Hays, Hidalgo, Hill, Hockley, Hood, Hunt, 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
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Assist (HMO) H5294-016
Counties: Armstrong, Atascosa, Bailey, Bandera, Borden, Bosque, Briscoe, Calhoun, Castro, Coke, Colorado, Crosby, DeWitt, Dickens, Dimmit, Ector, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Gonzales, Grayson, Grimes, Hamilton, Hill, Hockley, Hood, Hunt, Jack, Karnes, Kendall, Kent, Kimble, Lamb, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, Medina, Mills, Mitchell, Navarro, Nolan, Palo Pinto, Parker, Potter, Randall, Real, San Saba, Shackelford, Smith, Somervell, Sterling, Swisher, Terry, Throckmorton, Uvalde, Van Zandt, Wilson, Wise, Zavala
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Simple (HMO) H5294-017
Counties: Atascosa, Bandera, DeWitt, Dimmit, Gonzales, Karnes, Kendall, Maverick, Medina, Real, Uvalde, Wilson, Zavala
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Simple (HMO) H5294-018
Counties: Armstrong, Bailey, Borden, Briscoe, Castro, Coke, Crosby, Dickens, Ector, Fisher, Floyd, Garza, Glasscock, Hockley, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Giveback (HMO) H5294-019
Counties: Armstrong, Bailey, Borden, Briscoe, Castro, Coke, Crosby, Dickens, Ector, Fisher, Floyd, Garza, Glasscock, Hockley, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
Wellcare Simple (HMO) H5294-020
Counties: Potter, Randall
Annual Notice of Changes
Summary of Benefits
Evidence of Coverage
HMO D-SNP
Wellcare Dual Liberty (HMO D-SNP) H5294-010
Counties: Aransas, Armstrong, Atascosa, Bailey, Bandera, Bee, Borden, Bosque, Briscoe, Brooks, Calhoun, Cameron, Castro, Cochran, Coke, Colorado, Crosby, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, 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, 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 Changes
Summary of Benefits
Evidence of Coverage
Wellcare Dual Access (HMO D-SNP) H5294-015
Counties: Aransas, Armstrong, Atascosa, Bailey, Bandera, Bee, Borden, Bosque, Briscoe, Brooks, Calhoun, Cameron, Castro, Cochran, Coke, Colorado, Crosby, DeWitt, Dickens, Dimmit, Donley, Duval, Ector, Ellis, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, 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, 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 Changes
Summary of Benefits
Evidence of Coverage
Additional Forms
If you have questions please, contact Member Services.
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