Plan Materials and Forms

Information about plan benefits, services, and drug costs can be found in your plan materials.

Look at your Wellcare By Allwell member ID card for your plan number and type to view materials for your plan.

View a sample of an Wellcare By Allwell Member ID Card to see where this information is located.

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 Name	CMS #	County	Summary of Benefits
Wellcare No Premium Medicare (HMO)	H0062-002	Aransas, Bexar, Collin, Comal, Dallas, Denton, El Paso, Guadalupe, Jim Wells, Nueces, Rockwall, Tarrant, Wilson	Summary of Benefits, H0062-002 - English (PDF) Summary of Benefits, H0062-002 - Spanish (PDF)
Wellcare No Premium Medicare (HMO)	H0062-003	Cameron, Hidalgo, Starr	Summary of Benefits, H0062-003 - English (PDF) Summary of Benefits, H0062-003 - Spanish (PDF)
Wellcare No Premium (HMO)	H0174-010	Austin, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, San Jacinto, Walker, Waller, Wharton	Summary of Benefits, H0174-010 - English (PDF) Summary of Benefits, H0174-010 - Spanish (PDF)
Wellcare No Premium (HMO)	H5294-011	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	Summary of Benefits, H5294-011 - English (PDF) Summary of Benefits, H5294-011 - Spanish (PDF)
Wellcare No Premium (HMO)	H5294-017	Atascosa, Bandera, Bexar, Comal, DeWitt, Dimmit, Gonzales, Guadalupe, Karnes, Kendall, Maverick, Medina, Real, Uvalde, Wilson, and Zavala	Summary of Benefits, H5294-017 - English (PDF) Summary of Benefits, H5294-017 - Spanish (PDF)
Wellcare No Premium (HMO)	H5294-018	Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton	Summary of Benefits, H5294-018 - English (PDF) Summary of Benefits, H5294-018 - Spanish (PDF)
Wellcare TexanPlus Patriot Giveback (HMO)	H4506-010	Austin, Brazoria, Chambers, Fort Bend, Galveston (partial county), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Walker, Waller	Summary of Benefits, H4506-010 - English (PDF) Summary of Benefits, H4506-010 - Spanish (PDF)
Wellcare TexanPlus No Premium (HMO)	H0174-002	Bastrop, Blanco, Burnet, Caldwell, Hays, Lee, Milam, Travis, Williamson	Summary of Benefits, H0174-002 - English (PDF) Summary of Benefits, H0174-002 - Spanish (PDF)
Wellcare TexanPlus No Premium (HMO)	H0174-011-001	Bexar, Comal, Guadalupe	Summary of Benefits, H0174-011-001 - English (PDF) Summary of Benefits, H0174-011-001 - Spanish (PDF)
Wellcare TexanPlus No Premium (HMO)	H0174-011-002	El Paso	Summary of Benefits, H0174-011-002 - English (PDF) Summary of Benefits, H0174-011-002 - Spanish (PDF)
Wellcare TexanPlus No Premium (HMO)	H0174-011-003	Chambers, Galveston, Walker	Summary of Benefits, H0174-011-003 - English (PDF) Summary of Benefits, H0174-011-003 - Spanish (PDF)
Wellcare TexanPlus No Premium (HMO)	H0174-011-004	Cooke	Summary of Benefits, H0174-011-004 - English (PDF) Summary of Benefits, H0174-011-004 - Spanish (PDF)
Wellcare TexanPlus No Premium (HMO)	H0174-014	Collin, Dallas, Denton, Johnson, Rockwall, Tarrant	Summary of Benefits, H0174-014 - English (PDF) Summary of Benefits, H0174-014 - Spanish (PDF)
Wellcare TexanPlus Classic No Premium (HMO)	H4506-003	Austin, Brazoria, Chambers, Fort Bend, Galveston (partial County), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Walker, Waller	Summary of Benefits, H4506-003 - English (PDF) Summary of Benefits, H4506-003 - Spanish (PDF)
Wellcare Giveback (HMO)	H0174-013-001	Bastrop, Blanco, Burnet, Caldwell, Hays, Lee, Milam, Travis, Williamson	Summary of Benefits, H0174-013-001 - English (PDF) Summary of Benefits, H0174-013-001 - Spanish (PDF)
Wellcare Giveback (HMO)	H0174-013-002	Collin, Cooke, Dallas, Denton, Johnson, Rockwall, Tarrant	Summary of Benefits, H0174-013-002 - English (PDF) Summary of Benefits, H0174-013-002 - Spanish (PDF)
Wellcare Giveback (HMO)	H0174-013-003	Austin, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, Polk, San Jacinto, Walker, Waller, Wharton	Summary of Benefits, H0174-013-003 - English (PDF) Summary of Benefits, H0174-013-003 - Spanish (PDF)
Wellcare Giveback (HMO)	H0174-013-004	Bexar, Comal, Guadalupe	Summary of Benefits, H0174-013-004 - English (PDF) Summary of Benefits, H0174-013-004 - Spanish (PDF)
Wellcare Giveback (HMO)	H0174-013-005	El Paso	Summary of Benefits, H0174-013-005 - English (PDF) Summary of Benefits, H0174-013-005 - Spanish (PDF)
Wellcare Giveback (HMO)	H5294-012	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	Summary of Benefits, H5294-012 - English (PDF) Summary of Benefits, H5294-012 - Spanish (PDF)
Wellcare Giveback (HMO)	H5294-019	Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton	Summary of Benefits, H5294-019 - English (PDF) Summary of Benefits, H5294-019 - Spanish (PDF)
Wellcare Patriot No Premium (HMO)	H5294-014	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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, 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, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Zapata, Zavala	Summary of Benefits, H5294-014 - English (PDF) Summary of Benefits, H5294-014 - Spanish (PDF)
Wellcare Assist (HMO)	H0174-009	Austin, Bastrop, Bexar, Blanco, Burnet, Caldwell, Chambers, Collin, Comal, Cooke, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Jefferson, Johnson, Lee, Liberty, Matagorda, Milam, Montgomery, Newton, Orange, Polk, Rockwall, San Jacinto, Tarrant, Travis, Walker, Waller, Wharton, Williamson	Summary of Benefits, H0174-009 - English (PDF) Summary of Benefits, H0174-009 - Spanish (PDF)
Wellcare Complement Assist (HMO)	H5294-013	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	Summary of Benefits, H5294-013 - English (PDF) Summary of Benefits, H5294-013 - Spanish (PDF)
Wellcare Complement Assist (HMO)	H5294-016	Armstrong, 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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hill, Hockley, 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, Real, Rockwall, San Saba, Shackelford, Somervell, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Williamson, Wilson, Zavala	Summary of Benefits, H5294-016 - English (PDF) Summary of Benefits, H5294-016 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare Dual Access (HMO D-SNP)	H0174-004	Austin, Bastrop, Bexar, Blanco, Burnet, Caldwell, Chambers, Comal, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Jefferson, Johnson, Lee, Liberty, Matagorda, Milam, Montgomery, Newton, Orange, Polk, San Jacinto, San Patricio, Tarrant, Walker, Waller, Wharton	Summary of Benefits, H0174-004 - English (PDF) Summary of Benefits, H0174-004 - Spanish (PDF)
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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, 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, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Zapata, Zavala	Summary of Benefits, H5294-015 - English (PDF) Summary of Benefits, H5294-015 - Spanish (PDF)
Wellcare Dual Liberty (HMO D-SNP)	H0174-006	Austin, Bastrop, Bexar, Blanco, Burnet, Caldwell, Chambers, Comal, Cooke, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Jefferson, Johnson, Lee, Liberty, Matagorda, Milam, Montgomery, Newton, Orange, Polk, San Jacinto, San Patricio, Tarrant, Walker, Waller, Wharton	Summary of Benefits, H0174-006 - English (PDF) Summary of Benefits, H0174-006 - Spanish (PDF)
Wellcare Dual Liberty Nurture (HMO D-SNP)	H5294-010	Aransas, 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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hidalgo, Hill, Hockley, 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, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Wilson, Zapata, Zavala	Summary of Benefits, H5294-010 - English (PDF) Summary of Benefits, H5294-010 - Spanish (PDF)

For HMO C-SNP Members

Plan Name	CMS #	County	Summary of Benefits
Wellcare Specialty No Premium (HMO C-SNP)	H0174-008	Austin, Bexar, Chambers, Comal, El Paso, Fort Bend, Galveston, Guadalupe, Harris, Liberty, Matagorda, Montgomery, Polk, San Jacinto, Walker, Waller, Wharton	Summary of Benefits, H0174-008 - English (PDF) Summary of Benefits, H0174-008 - Spanish (PDF)

For HMO-POS Members

Plan Name	CMS #	County	Summary of Benefits
Wellcare No Premium (HMO-POS)	H0174-012-001	Bastrop, Blanco, Burnet, Caldwell, Hays, Lee, Milam, Travis, Williamson	Summary of Benefits, H0174-012-001 - English (PDF) Summary of Benefits, H0174-012-001 - Spanish (PDF)
Wellcare No Premium (HMO-POS)	H0174-012-002	Collin, Cooke, Dallas, Denton, Johnson, Rockwall, Tarrant	Summary of Benefits, H0174-012-002 - English (PDF) Summary of Benefits, H0174-012-002 - Spanish (PDF)
Wellcare No Premium (HMO-POS)	H0174-012-003	Austin, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, Polk, San Jacinto, Walker, Waller, Wharton	Summary of Benefits, H0174-012-003 - English (PDF) Summary of Benefits, H0174-012-003 - Spanish (PDF)
Wellcare No Premium (HMO-POS)	H0174-012-004	Bexar, Comal, Guadalupe	Summary of Benefits, H0174-012-004 - English (PDF) Summary of Benefits, H0174-012-004 - Spanish (PDF)
Wellcare No Premium (HMO-POS)	H0174-012-005	El Paso	Summary of Benefits, H0174-012-005 - English (PDF) Summary of Benefits, H0174-012-005 - Spanish (PDF)
Wellcare TexanPlus No Premium (HMO-POS)	H4506-029	Austin, Brazoria, Chambers, Fort Bend, Galveston (partial county), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Walker, Waller	Summary of Benefits, H4506-029 - English (PDF) Summary of Benefits, H4506-029 - Spanish (PDF)

For PPO Members

Plan Name	CMS #	County	Summary of Benefits
Wellcare Low Premium Open (PPO)	H7323-001	Bastrop, Blanco, Burnet, Caldwell, Hays, Lee, Milam, Travis, Williamson	Summary of Benefits, H7323-001 - English (PDF) Summary of Benefits, H7323-001 - Spanish (PDF)
Wellcare Low Premium Open (PPO)	H7323-002	Collin, Dallas, Denton, Johnson, Rockwall, Tarrant	Summary of Benefits, H7323-002 - English (PDF) Summary of Benefits, H7323-002 - Spanish (PDF)
Wellcare Low Premium Open (PPO)	H7323-003	Austin, Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Polk, San Jacinto, Walker, Waller	Summary of Benefits, H7323-003 - English (PDF) Summary of Benefits, H7323-003 - Spanish (PDF)
Wellcare No Premium Open (PPO)	H7323-004	Atascosa, Bexar, El Paso, Medina	Summary of Benefits, H7323-004 - English (PDF) Summary of Benefits, H7323-004 - Spanish (PDF)
Wellcare Dual Access Open (PPO D-SNP)	H7323-005	Atascosa, Austin, Bastrop, Bexar, Blanco, Brazoria, Burnet, Caldwell, Chambers, Collin, Comal, Cooke, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Hidalgo, Jefferson, Johnson, Lee, Liberty, Medina, Milam, Montgomery, Orange, Polk, Rockwall, San Jacinto, Starr, Tarrant, Travis, Walker, Waller, Williamson	Summary of Benefits, H7323-005 - English (PDF) Summary of Benefits, H7323-005 - Spanish (PDF)
Wellcare No Premium Rx Plus Open (PPO)	H7323-006		Summary of Benefits, H7323-006 - English (PDF) Summary of Benefits, H7323-006 - Spanish (PDF)
Wellcare No Premium Open (PPO)	H7323-007	Hidalgo, Starr	Summary of Benefits, H7323-007 - English (PDF) Summary of Benefits, H7323-007 - Spanish (PDF)

For PPO D-SNP Members

Plan Name	CMS #	County	Summary of Benefits
Wellcare Dual Access Open (PPO D-SNP)	H7323-005	Atascosa, Austin, Bastrop, Bexar, Blanco, Brazoria, Burnet, Caldwell, Chambers, Collin, Comal, Cooke, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Hidalgo, Jefferson, Johnson, Lee, Liberty, Medina, Milam, Montgomery, Orange, Polk, Rockwall, San Jacinto, Starr, Tarrant, Travis, Walker, Waller, Williamson	Summary of Benefits, H7323-005 - English (PDF) Summary of Benefits, H7323-005 - Spanish (PDF)

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:

For HMO Members:

Plan Name	CMS #	County	Evidence of Coverage
Wellcare No Premium Medicare (HMO)	H0062-002	Aransas, Bexar, Collin, Comal, Dallas, Denton, El Paso, Guadalupe, Jim Wells, Nueces, Rockwall, Tarrant, Wilson	Evidence of Coverage, H0062-002 - English (PDF) Evidence of Coverage, H0062-002 - Spanish (PDF)
Wellcare No Premium Medicare (HMO)	H0062-003	Cameron, Hidalgo, Starr	Evidence of Coverage, H0062-003 - English (PDF) Evidence of Coverage H0062-003 - Spanish (PDF)
Wellcare No Premium (HMO)	H0174-010	Austin, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, San Jacinto, Walker, Waller, Wharton	Evidence of Coverage, H0174-010 - English (PDF) Evidence of Coverage, H0174-010 - Spanish (PDF) - coming soon
Wellcare No Premium (HMO)	H5294-011	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	Evidence of Coverage, H5294-011 - English (PDF) Evidence of Coverage, H5294-011 - Spanish (PDF)
Wellcare No Premium (HMO)	H5294-017	Atascosa, Bandera, Bexar, Comal, DeWitt, Dimmit, Gonzales, Guadalupe, Karnes, Kendall, Maverick, Medina, Real, Uvalde, Wilson, Zavala	Evidence of Coverage, H5294-017 - English (PDF) Evidence of Coverage, H5294-017 - Spanish (PDF)
Wellcare No Premium (HMO)	H5294-018	Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton	Evidence of Coverage, H5294-018 - English (PDF) Evidence of Coverage, H5294-018 - Spanish (PDF)
Wellcare TexanPlus Patriot Giveback (HMO)	H4506-010	Austin, Brazoria, Chambers, Fort Bend, Galveston (partial county), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Walker, Waller	Evidence of Coverage, H4506-010 - English (PDF) Evidence of Coverage, H4506-010 - Spanish (PDF) - coming soon
Wellcare TexanPlus No Premium (HMO)	H0174-002	Bastrop, Blanco, Burnet, Caldwell, Hays, Lee, Milam, Travis, Williamson	Evidence of Coverage, H0174-002 - English (PDF) Evidence of Coverage, H0174-002 - Spanish (PDF) - coming soon
Wellcare TexanPlus No Premium (HMO)	H0174-011-001	Bexar, Comal, Guadalupe	Evidence of Coverage, H0174-011-001 - English (PDF) Evidence of Coverage, H0174-011-001 - Spanish (PDF) - coming soon
Wellcare TexanPlus No Premium (HMO)	H0174-011-002	El Paso	Evidence of Coverage, H0174-011-002 - English (PDF) Evidence of Coverage, H0174-011-002 - Spanish (PDF) - coming soon
Wellcare TexanPlus No Premium (HMO)	H0174-011-003	Chambers, Galveston, Walker	Evidence of Coverage, H0174-011-003 - English (PDF) Evidence of Coverage, H0174-011-003 - Spanish (PDF) - coming soon
Wellcare TexanPlus No Premium (HMO)	H0174-011-004	Cooke	Evidence of Coverage, H0174-011-004 - English (PDF) Evidence of Coverage, H0174-011-004 - Spanish (PDF) - coming soon
Wellcare TexanPlus No Premium (HMO)	H0174-014	Collin, Dallas, Denton, Johnson, Rockwall, Tarrant	Evidence of Coverage, H0174-014 - English (PDF) Evidence of Coverage, H0174-014 - Spanish (PDF) - coming soon
Wellcare TexanPlus Classic No Premium (HMO)	H4506-003	Austin, Brazoria, Chambers, Fort Bend, Galveston (partial County), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Walker, Waller	Evidence of Coverage, H4506-003 - English (PDF) Evidence of Coverage, H4506-003 - Spanish (PDF) - coming soon
Wellcare Giveback (HMO)	H0174-013-001	Bastrop, Blanco, Burnet, Caldwell, Hays, Lee, Milam, Travis, Williamson	Evidence of Coverage, H0174-013-001 - English (PDF) Evidence of Coverage, H0174-013-001 - Spanish (PDF) - coming soon
Wellcare Giveback (HMO)	H0174-013-002	Collin, Cooke, Dallas, Denton, Johnson, Rockwall, Tarrant	Evidence of Coverage, H0174-013-002 - English (PDF) Evidence of Coverage, H0174-013-002 - Spanish (PDF) - coming soon
Wellcare Giveback (HMO)	H0174-013-003	Austin, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, Polk, San Jacinto, Walker, Waller, Wharton	Evidence of Coverage, H0174-013-003 - English (PDF) Evidence of Coverage, H0174-013-003 - Spanish (PDF) - coming soon
Wellcare Giveback (HMO)	H0174-013-004	Bexar, Comal, Guadalupe	Evidence of Coverage, H0174-013-004 - English (PDF) Evidence of Coverage, H0174-013-004 - Spanish (PDF) - coming soon
Wellcare Giveback (HMO)	H0174-013-005	El Paso	Evidence of Coverage, H0174-013-005 - English (PDF) Evidence of Coverage, H0174-013-005 - Spanish (PDF) - coming soon
Wellcare Giveback (HMO)	H5294-012	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	Evidence of Coverage, H5294-012 - English (PDF) Evidence of Coverage, H5294-012 - Spanish (PDF)
Wellcare Giveback (HMO)	H5294-019	Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton	Evidence of Coverage, H5294-019 - English (PDF) Evidence of Coverage, H5294-019 - Spanish (PDF)
Wellcare Patriot No Premium (HMO)	H5294-014	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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, 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, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Zapata, Zavala	Evidence of Coverage, H5294-014 - English (PDF) Evidence of Coverage, H5294-014 - Spanish (PDF)
Wellcare Assist (HMO)	H0174-009	Austin, Bastrop, Bexar, Blanco, Burnet, Caldwell, Chambers, Collin, Comal, Cooke, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Jefferson, Johnson, Lee, Liberty, Matagorda, Milam, Montgomery, Newton, Orange, Polk, Rockwall, San Jacinto, Tarrant, Travis, Walker, Waller, Wharton, Williamson	Evidence of Coverage, H0174-009 - English (PDF) Evidence of Coverage, H0174-009 - Spanish (PDF) - coming soon
Wellcare Complement Assist (HMO)	H5294-013	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	Evidence of Coverage, H5294-013 - English (PDF) Evidence of Coverage, H5294-013 - Spanish (PDF)
Wellcare Complement Assist (HMO)	H5294-016	Armstrong, 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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hill, Hockley, 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, Real, Rockwall, San Saba, Shackelford, Somervell, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Williamson, Wilson, Zavala	Evidence of Coverage, H5294-016 - English (PDF) Evidence of Coverage, H5294-016 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Evidence of Coverage
Wellcare Dual Access (HMO D-SNP)	H0174-004	Austin, Bastrop, Bexar, Blanco, Burnet, Caldwell, Chambers, Comal, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Jefferson, Johnson, Lee, Liberty, Matagorda, Milam, Montgomery, Newton, Orange, Polk, San Jacinto, San Patricio, Tarrant, Walker, Waller, Wharton	Evidence of Coverage, H0174-004 - English (PDF) Evidence of Coverage, H0174-004 - Spanish (PDF) - coming soon
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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, 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, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Zapata, Zavala	Evidence of Coverage, H5294-015 - English (PDF) Evidence of Coverage, H5294-015 - Spanish (PDF)
Wellcare Dual Liberty (HMO D-SNP)	H0174-006	Austin, Bastrop, Bexar, Blanco, Burnet, Caldwell, Chambers, Comal, Cooke, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Jefferson, Johnson, Lee, Liberty, Matagorda, Milam, Montgomery, Newton, Orange, Polk, San Jacinto, San Patricio, Tarrant, Walker, Waller, Wharton	Evidence of Coverage, H0174-006 - English (PDF) Evidence of Coverage, H0174-006 - Spanish (PDF) - coming soon
Wellcare Dual Liberty Nurture (HMO D-SNP)	H5294-010	Aransas, 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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hidalgo, Hill, Hockley, 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, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Wilson, Zapata, Zavala	Evidence of Coverage, H5294-010 - English (PDF) Evidence of Coverage, H5294-010 - Spanish (PDF)

For HMO C-SNP Members

Plan Name	CMS #	County	Evidence of Coverage
Wellcare Specialty No Premium (HMO C-SNP)	H0174-008	Austin, Bexar, Chambers, Comal, El Paso, Fort Bend, Galveston, Guadalupe, Harris, Liberty, Matagorda, Montgomery, Polk, San Jacinto, Walker, Waller, Wharton	Evidence of Coverage, H0174-008 - English (PDF) Evidence of Coverage, H0174-008 - Spanish (PDF) - coming soon

For HMO-POS Members

Plan Name	CMS #	County	Evidence of Coverage
Wellcare No Premium (HMO-POS)	H0174-012-001	Bastrop, Blanco, Burnet, Caldwell, Hays, Lee, Milam, Travis, Williamson	Evidence of Coverage, H0174-012-001 - English (PDF) Evidence of Coverage, H0174-012-001 - Spanish (PDF) - coming soon
Wellcare No Premium (HMO-POS)	H0174-012-002	Collin, Cooke, Dallas, Denton, Johnson, Rockwall, Tarrant	Evidence of Coverage, H0174-012-002 - English (PDF) Evidence of Coverage, H0174-012-002 - Spanish (PDF) - coming soon
Wellcare No Premium (HMO-POS)	H0174-012-003	Austin, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, Polk, San Jacinto, Walker, Waller, Wharton	Evidence of Coverage, H0174-012-003 - English (PDF) Evidence of Coverage, H0174-012-003 - Spanish (PDF) - coming soon
Wellcare No Premium (HMO-POS)	H0174-012-004	Bexar, Comal, Guadalupe	Evidence of Coverage, H0174-012-004 - English (PDF) Evidence of Coverage, H0174-012-004 - Spanish (PDF) - coming soon
Wellcare No Premium (HMO-POS)	H0174-012-005	El Paso	Evidence of Coverage, H0174-012-005 - English (PDF) Evidence of Coverage, H0174-012-005 - Spanish (PDF) - coming soon
Wellcare TexanPlus No Premium (HMO-POS)	H4506-029	Austin, Brazoria, Chambers, Fort Bend, Galveston (partial county), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Walker, Waller	Evidence of Coverage, H4506-029 - English (PDF) Evidence of Coverage, H4506-029 - Spanish (PDF) - coming soon

For PPO Members

Plan Name	CMS #	County	Evidence of Coverage
Wellcare No Premium Open (PPO)	H7323-001	Bastrop, Blanco, Burnet, Caldwell, Hays, Lee, Milam, Travis, Williamson	Evidence of Coverage, H7323-001 - English (PDF) Evidence of Coverage, H7323-001 - Spanish (PDF) - coming soon
Wellcare No Premium Open (PPO)	H7323-002	Collin, Dallas, Denton, Johnson, Rockwall, Tarrant	Evidence of Coverage, H7323-002 - English (PDF) Evidence of Coverage, H7323-002 - Spanish (PDF) - coming soon
Wellcare No Premium Open (PPO)	H7323-003	Austin, Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Polk, San Jacinto, Walker, Waller	Evidence of Coverage, H7323-003 - English (PDF) Evidence of Coverage, H7323-003 - Spanish (PDF) - coming soon
Wellcare No Premium Open (PPO)	H7323-004	Atascosa, Bexar, El Paso, Medina	Evidence of Coverage, H7323-004 - English (PDF) Evidence of Coverage, H7323-004 - Spanish (PDF) - coming soon
Wellcare No Premium Rx Plus Open (PPO)	H7323-006	Atascosa, Austin, Bastrop, Bexar, Blanco, Brazoria, Burnet, Caldwell, Chambers, Collin, Comal, Cooke, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Hidalgo, Jefferson, Johnson, Lee, Liberty, Medina, Milam, Montgomery, Orange, Polk, Rockwall, San Jacinto, Starr, Tarrant, Travis, Walker, Waller, Williamson	Evidence of Coverage, H7323-006 - English (PDF) Evidence of Coverage, H7323-006 - Spanish (PDF) - coming soon
Wellcare No Premium Open (PPO)	H7323-007	Hidalgo, Starr	Evidence of Coverage, H7323-007 - English (PDF) Evidence of Coverage, H7323-007 - Spanish (PDF) - coming soon

For PPO D-SNP Members

Plan Name	CMS #	County	Evidence of Coverage
Wellcare Dual Access Open (PPO D-SNP)	H7323-005	Atascosa, Austin, Bastrop, Bexar, Blanco, Brazoria, Burnet, Caldwell, Chambers, Collin, Comal, Cooke, Dallas, Denton, El Paso, Fort Bend, Galveston, Guadalupe, Hardin, Harris, Hays, Hidalgo, Jefferson, Johnson, Lee, Liberty, Medina, Milam, Montgomery, Orange, Polk, Rockwall, San Jacinto, Starr, Tarrant, Travis, Walker, Waller, Williamson	Evidence of Coverage, H7323-005 - English (PDF) Evidence of Coverage, H7323-005 - Spanish (PDF) - coming soon

If you were enrolled in Superior HealthPlan Medicare Advantage last year, 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 Name	CMS #	County	Annual Notice of Changes
Wellcare No Premium Medicare (HMO)	H0062-002	Aransas, Bexar, Collin, Comal, Dallas, Denton, El Paso, Guadalupe, Jim Wells, Nueces, Rockwall, Tarrant, Wilson	Annual Notice of Changes, H0062-002 - English (PDF) Annual Notice of Changes, H0062-002 - Spanish (PDF)
Allwell Medicare (HMO) to Wellcare No Premium Medicare (HMO)	H0062-001 - H0062-002	Aransas, Bexar, Collin, Comal, Dallas, Denton, El Paso, Guadalupe, Jim Wells, Nueces, Rockwall, Tarrant, Wilson	Annual Notice of Changes, H0062-001 - H0062-002 - English (PDF) Annual Notice of Changes, H0062-001 - H0062-002 - Spanish (PDF)
Wellcare No Premium Medicare (HMO)	H0062-003	Cameron, Hidalgo, Starr	Annual Notice of Changes, H0062-003 - English (PDF) Annual Notice of Changes H0062-003 - Spanish (PDF)
Wellcare No Premium (HMO)	H5294-011	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, H5294-011 - English (PDF) Annual Notice of Changes H5294-011 - Spanish (PDF)
Wellcare Giveback (HMO)	H5294-012		Annual Notice of Changes, H5294-012 - English (PDF) Annual Notice of Changes H5294-012 - Spanish (PDF)
Wellcare Complement Assist (HMO)	H5294-013		Annual Notice of Changes, H5294-013 - English (PDF) Annual Notice of Changes H5294-013 - Spanish (PDF)
Wellcare Patriot No Premium (HMO)	H5294-014		Annual Notice of Changes, H5294-014 - English (PDF) Annual Notice of Changes H5294-014 - Spanish (PDF)
Wellcare Complement Assist (HMO)	H5294-016		Annual Notice of Changes, H5294-016 - English (PDF) Annual Notice of Changes H5294-016 - Spanish (PDF)
Wellcare No Premium (HMO)	H5294-017	Atascosa, Bandera, Bexar, Comal, DeWitt, Dimmit, Gonzales, Guadalupe, Karnes, Kendall, Maverick, Medina, Real, Uvalde, Wilson, Zavala	Annual Notice of Changes, H5294-017 - English (PDF) Annual Notice of Changes H5294-017 - Spanish (PDF)
Wellcare No Premium (HMO)	H5294-018	Armstrong, Bailey, Borden, Briscoe, Castro, Cochran, Coke, Crosby, Dickens, Donley, Fisher, Floyd, Garza, Glasscock, Hale, Hockley, Irion, Kent, Lamb, Lubbock, Lynn, Martin, Mitchell, Nolan, Shackelford, Sterling, Swisher, Terry, Throckmorton	Annual Notice of Changes, H5294-018 - English (PDF) Annual Notice of Changes H5294-018 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare Dual Liberty Nurture (HMO D-SNP)	H5294-010	Aransas, 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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hidalgo, Hill, Hockley, 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, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Wilson, Zapata, Zavala	Annual Notice of Changes, H5294-010 - English (PDF) Annual Notice of Changes, H5294-010 - Spanish (PDF)
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, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grayson, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, 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, Real, Refugio, Rockwall, San Patricio, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Van Zandt, Victoria, Webb, Willacy, Williamson, Wilson, Zapata, Zavala	Annual Notice of Changes, H5294-015 - English (PDF) Annual Notice of Changes, H5294-015 - Spanish (PDF)
Allwell Medicare Nurture (HMO D-SNP) to Wellcare Dual Access Harmony (HMO D-SNP)	H5294-010 - H5294-015		Annual Notice of Changes, H5294-010 - H5294-015 - English (PDF) Annual Notice of Changes, H5294-010 - H5294-015 - Spanish (PDF)

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Member Health Library

Plan Benefit Materials | Allwell from Superior HealthPlan

Plan Materials and Forms

For HMO Members:

For HMO D-SNP Members:

For HMO C-SNP Members

For HMO-POS Members

For PPO Members

For PPO D-SNP Members

For HMO Members:

For HMO D-SNP Members:

For HMO C-SNP Members

For HMO-POS Members

For PPO Members

For PPO D-SNP Members

Take Charge of Your Mental Health

Plan Benefit Materials

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

Take Charge of Your Mental Health

Plan Benefit Materials | Allwell from Superior HealthPlan

Plan Materials and Forms

Summary of Benefits (SB)

For HMO Members:

For HMO D-SNP Members:

For HMO C-SNP Members

For HMO-POS Members

For PPO Members

For PPO D-SNP Members

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D-SNP Members:

For HMO C-SNP Members

For HMO-POS Members

For PPO Members

For PPO D-SNP Members

Annual Notice of Changes (ANOC)

Member Newsletters

myStrength

Take Charge of Your Mental Health

Member Health Library

Over-The-Counter Benefits

Plan Benefit Materials

Summary of Benefits (SB)

For HMO Members:

For HMO D-SNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D-SNP Members:

Annual Notice of Changes (ANOC)

For HMO Members:

For HMO D-SNP Members:

myStrength

Take Charge of Your Mental Health

Member Health Library

Over-The-Counter Benefits