Plan Benefit Materials | Allwell from Western Sky Community Care

Plan Materials and Forms

 

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

You can also look for plan materials based on the plan name and the county you live in.

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 (HMO) H2134-005 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia

For HMO D-SNP Members:

Plan Name  CMS # County Summary of Benefits
Wellcare Dual Liberty (HMO D-SNP) H2134-001 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia
Wellcare All  Dual (HMO D-SNP) H2134-003 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia

For PPO Members:

Plan Name CMS # County Summary of Benefits
Wellcare No Premium Open (PPO) H9976-002 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia

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 (HMO) H2134-005 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia
 

For HMO D-SNP Members:

Plan Name  CMS # County Evidence of Coverage
Wellcare Dual Liberty (HMO D-SNP) H2134-001 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia

 

 
Wellcare All Dual (HMO D-SNP) H2134-003 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia

 

 

For PPO Members:

Plan Name  CMS # County Evidence of Coverage
Wellcare No Premium Open (PPO) H9976-002 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia
 

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 Annual Notice of Change (ANOC)
Wellcare Assist (HMO) to Wellcare No Premium (HMO) H2134-004 to H2134-005 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia
 
Wellcare No Premium (HMO) H2134-005 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia

For HMO-DSNP Members:

Plan Name  CMS # County Annual Notice of Change (ANOC)
Wellcare Dual Liberty (HMO D-SNP) H2134-001 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia
Wellcare Assist (HMO) to Wellcare Dual Liberty (HMO D-SNP) H2134-004 to H2134-001 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia
Wellcare All Dual (HMO D-SNP) H2134-003 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia
Wellcare Assist (HMO) to Wellcare All Dual (HMO D-SNP) H2134-004 to H2134-003 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia

For PPO Members:

Plan Name  CMS # County Annual Notice of Change (ANOC)
Wellcare No Premium Open (PPO) H9976-002 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia
Wellcare Assist Open (PPO) to Wellcare No Premium Open (PPO) H9976-001 to H9976- 002 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Eddy, Grant, Lea, Lincoln, Los Alamos, Luna, McKinley, Otero, Quay, Rio Arriba, Roosevelt, San Miguel, Sandoval, Santa Fe, Taos, Torrance, Valencia