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)	H1436-002	Abbeville, Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Edgefield, Florence, Georgetown, Greenwood, Hampton, Jasper, Laurens, Lee, Marion, Marlboro, McCormick, Newberry, Orangeburg, Union, Williamsburg	Summary of Benefits, H1436-002 - English (PDF)
Wellcare No Premium Medicare (HMO)	H1436-004	Anderson, Calhoun, Fairfield, Greenville, Kershaw, Lexington, Oconee, Pickens, Richland, Saluda, Spartanburg	Summary of Benefits, H1436-004 - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Summary of Benefits
Wellcare Dual Liberty (HMO D-SNP)	H1436-007	Darlington, Dillon, Florence, Marion, Marlboro	Summary of Benefits, H1436-007 - English (PDF)
Wellcare Dual Access (HMO D-SNP)	H1436-005	Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York	Summary of Benefits, H1436-005 - English (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)	H1436-002	Abbeville, Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Edgefield, Florence, Georgetown, Greenwood, Hampton, Jasper, Laurens, Lee, Marion, Marlboro, McCormick, Newberry, Orangeburg, Union, Williamsburg	Evidence of Coverage, H1436-002 - English (PDF)
Wellcare No Premium Medicare (HMO)	H1436-004	Anderson, Calhoun, Fairfield, Greenville, Kershaw, Lexington, Oconee, Pickens, Richland, Saluda, Spartanburg	Evidence of Coverage, H1436-004 - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage

Wellcare No Premium Medicare (HMO)

H1436-002

Abbeville, Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Edgefield, Florence, Georgetown, Greenwood, Hampton, Jasper, Laurens, Lee, Marion, Marlboro, McCormick, Newberry, Orangeburg, Union, Williamsburg

Evidence of Coverage, H1436-002 - English (PDF)

Wellcare No Premium Medicare (HMO)

H1436-004

Anderson, Calhoun, Fairfield, Greenville, Kershaw, Lexington, Oconee, Pickens, Richland, Saluda, Spartanburg

Evidence of Coverage, H1436-004 - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Evidence of Coverage
Wellcare Dual Liberty (HMO D-SNP)	H1436-007	Darlington, Dillon, Florence, Marion, Marlboro	Evidence of Coverage, H1436-007 - English (PDF)
Wellcare Dual Access (HMO D-SNP)	H1436-005	Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York	Evidence of Coverage, H1436-005 - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage

Wellcare Dual Liberty (HMO D-SNP)

H1436-007

Darlington, Dillon, Florence, Marion, Marlboro

Evidence of Coverage, H1436-007 - English (PDF)

Wellcare Dual Access (HMO D-SNP)

H1436-005

Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York

Evidence of Coverage, H1436-005 - English (PDF)

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)	H1436-002	Abbeville, Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Edgefield, Florence, Georgetown, Greenwood, Hampton, Jasper, Laurens, Lee, Marion, Marlboro, McCormick, Newberry, Orangeburg, Union, Williamsburg	Annual Notice of Changes, H1436-002 - English (PDF)
Wellcare No Premium Medicare (HMO)	H1436-004	Anderson, Calhoun, Fairfield, Greenville, Kershaw, Lexington, Oconee, Pickens, Richland, Saluda, Spartanburg	Annual Notice of Changes, H1436-004 - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Annual Notice Of Changes
Wellcare Dual Access (HMO D-SNP)	H1436-005	Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York	Annual Notice of Changes, H1436-005 - English (PDF)

Quality Improvement Program (PDF)

Preventive Guidelines

Preventive guidelines are based on the health needs and opportunities for improvement identified as part of the Quality Assurance Program Improvement (QAPI) program. When possible, Absolute Total Care adopts preventive guidelines that are published by nationally recognized organizations or government institutions. These guidelines may also be a statewide collaborative and/or a consensus of healthcare professionals in the applicable field.

H1723_19_CPGWeb_Approved_07082019

Over-The-Counter Catalog - English (PDF)

Plan Benefit Materials | Allwell from Absolute Total Care

Plan Materials and Forms

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

Preventive Guidelines

Plan Benefit Materials

For HMO Members:

For HMO SNP Members:

For HMO Members:

For HMO SNP Members:

For HMO Members:

For HMO SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Allwell Medicare (HMO)	H1436-002	Abbeville, Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Edgefield, Florence, Georgetown, Greenwood, Hampton, Jasper, Laurens, Lee, Marion, Marlboro, McCormick, Newberry, Orangeburg, Union and Williamsburg counties	Summary of Benefits, H1436-002 - English (PDF)
Allwell Medicare (HMO)	H1436-004	Anderson, Calhoun, Fairfield, Greenville, Kershaw, Lexington, Oconee, Pickens, Richland, Saluda and Spartanburg counties	Summary of Benefits, H1436-004 - English (PDF)

Plan Benefit Materials | Allwell from Absolute Total Care

Plan Materials and Forms

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)

Quality Improvement

Preventive Guidelines

Over-The-Counter Benefits

Plan Benefit Materials

Summary of Benefits (SB)

For HMO Members:

For HMO SNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO SNP Members:

Annual Notice of Changes (ANOC)

For HMO Members:

For HMO SNP Members: