Plan Benefit Materials | Wellcare by Allwell Indiana

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 Complete No Premium (HMO)	H7925- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Summary of Benefits, H7925-002 - English (PDF)

For PPO Members

Plan Name	CMS #	County	Summary of Benefits
Wellcare Complete No Premium Open (PPO)	H1774- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Summary of Benefits, H1774-001 - 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 (EOC)
Wellcare Complete No Premium (HMO)	H7925- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Evidence of Coverage, H7925-002 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage (EOC)

Wellcare Complete No Premium (HMO)

H7925- 002

Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick

Evidence of Coverage, H7925-002 - English (PDF)

Dental Benefit Details - English (PDF)

For PPO Members

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Wellcare Complete No Premium Open (PPO)	H1774- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Evidence of Coverage, H1774-001 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage (EOC)

Wellcare Complete No Premium Open (PPO)

H1774- 001

Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick

Evidence of Coverage, H1774-001 - English (PDF)

Dental Benefit Details - English (PDF)

For HMO Members

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Wellcare Complete No Premium (HMO)	H7925- 002	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Annual Notice of Changes, H7925-002 - English (PDF)

For PPO Members

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare Complete No Premium Open (PPO)	H1774- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Annual Notice of Changes, H1774-001 - English (PDF)
Wellcare Complete No Premium Open (PPO)	H1774- 002 to H1774- 001	Boone, Cass, Clinton, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Madison, Miami, Montgomery, Posey, Putnam, Randolph, Shelby, Tipton, Vanderburgh, Warrick	Annual Notice of Changes, H1774- 002 to H1774- 001 - English (PDF)

Medicare Step Therapy Part B (PDF)

Covered Diabetes Testing Supplies

Over-the-Counter (OTC) Catalog (PDF)

Indiana Plan Benefit Materials

Indiana Plan Benefit Materials

HMO

Wellcare Complete Simple (HMO) H7925-002

PPO

Wellcare Complete Simple Open (PPO) H1774-001

Indiana Plan Benefit Materials

Summary of Benefits (SB)

Evidence Of Coverage (EOC)

Annual Notice of Changes (ANOC)

Step Therapy Part B

Covered Diabetes Testing Supplies

Over-the-Counter (OTC) Catalog

Indiana Plan Benefit Materials

HMO

Wellcare Complete Simple (HMO) H7925-002

Plan Benefits - coming soon

PPO

Wellcare Complete Simple Open (PPO) H1774-001

Plan Benefits