Materiales de los beneficios del plan | Allwell de MHS Health Wisconsin

Plan Materials and Forms

 

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

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

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 por 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 D-SNP Members:  

Plan NameCMS#CountySummary of Benefits

Wellcare Dual Access (HMO D-SNP)

H8189-001

Adams, Brown, Calumet, Clark, Columbia, Dane, Dodge, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

  • Summary of Benefits, H8189-001 - English (PDF) -Coming Soon

Wellcare All Dual Assure (HMO D-SNP)

H8189-007

Adams, Brown, Calumet, Clark, Columbia, Dane, Dodge, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

  • Summary of Benefits, H8189-007 - English (PDF) -Coming Soon

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

For HMO D-SNP Members:  

Plan NameCMS#County Evidence of Coverage

Wellcare Dual Access (HMO D-SNP)

H8189-001

Adams, Brown, Calumet, Clark, Columbia, Dane, Dodge, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

  • Evidence of Coverage, H8189-001 - English (PDF) - Coming Soon

Wellcare All Dual Assure (HMO D-SNP)

H8189-007

Adams, Brown, Calumet, Clark, Columbia, Dane, Dodge, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

Summary of Benefits, H8189-007 - English (PDF) - Coming Soon

If you were enrolled in Allwell from MHS Health Wisconsin 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 D-SNP Members:  

Plan NameCMS#County Annual Notice Of Changes
Wellcare Dual Access (HMO D-SNP) DSNPH8189-001

Adams, Brown, Calumet, Clark, Columbia, Dane, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, and Wood counties

  • Medicare Step Therapy Part B (PDF)