MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
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.
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 (HMO) | H2134-005 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare Patriot No Premium (HMO) | H2134-006 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare Giveback (HMO) | H2134-002 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare Assist (HMO) | H2134-004 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, 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, Luna, McKinley, Quay, Rio Arriba, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Dual Access (HMO D-SNP) | H2134-003 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, San Juan, 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, Luna, McKinley, Quay, Rio Arriba, Roosevelt, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Low Premium Open (PPO) | H9976-003 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Assist Open (PPO) | H9976-001 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Giveback Open (PPO) | H9976-004 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, 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 Patriot No Premium (HMO) MA Only | H2134-006 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare Giveback (HMO) MAPD | H2134-002 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare Assist (HMO) MAPD | H2134-004 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare No Premium (HMO) MAPD | H2134-005 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, 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, Luna, McKinley, Quay, Rio Arriba, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Dual Access (HMO D-SNP) | H2134-003 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, Valencia |
For PPO Members:
Plan Name | CMS # | County | Evidence of Coverage |
---|---|---|---|
Wellcare Assist Open (PPO) | H9976-001 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare No Premium Open (PPO) | H9976-002 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Low Premium Open (PPO) | H9976-003 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Giveback Open (PPO) | H9976-004 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, 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:
Plan Name | CMS # | County | Annual Notice of Change (ANOC) |
---|---|---|---|
Wellcare Dual Liberty (HMO D-SNP) | H2134-001 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Giveback (HMO) | H2134-002 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare Dual Access (HMO D-SNP) | H2134-003 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Allwell Dual Medicare (HMO D-SNP) to Wellcare Dual Access (HMO D-SNP) | H2134-001 - H2134-003 | Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Rio Arriba, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, Valencia | |
Wellcare Assist (HMO) | H2134-004 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare No Premium (HMO) | H2134-005 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia | |
Wellcare Patriot No Premium (HMO) | H2134-006 | Bernalillo, Dona Ana, Rio Arriba, Sandoval, Santa Fe, Torrance, Valencia |
Wellcare Giveback (HMO)
- Optional Supplemental Benefits Flyer English (PDF)
- Optional Supplemental Benefits Flyer Spanish (PDF)