Kansas Plan Materials and Forms


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 NameCMS# CountySummary of Benefits
Wellcare Complete No Premium (HMO)H5398-002Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
Wellcare Complete - Giveback (HMO)H5398- 004Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

For PPO Members:

Plan NameCMS# CountySummary of Benefits
Wellcare Complete No Premium Open (PPO)H6830-001Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

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 NameCMS # CountyEvidence of Coverage (EOC)
Wellcare Complete No Premium (HMO)H5398-002Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
Wellcare Complete - Giveback (HMO)H5398- 004Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

 

For PPO Members: 

Plan NameCMS#CountyEvidence of Coverage (EOC)
Wellcare Complete No Premium Open (PPO)H6830-001Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

If you were enrolled in Ascension Complete 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 Members

Plan NameCMS # CountyAnnual Notice of Changes (ANOC)
Wellcare Complete No Premium (HMO)H5398-002Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
Wellcare Complete - Giveback (HMO)H5398- 004Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

 

For PPO Members:

Plan NameCMS# CountyAnnual Notice of Changes (ANOC)
Wellcare Complete No Premium Open (PPO)H6830-001Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
Wellcare Complete No Premium Open (PPO)H6830-002 to H6830-001Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

If you have any questions please, contact Member Services.