Plan Benefit Materials | Wellcare by Allwell Michigan

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)	H0482- 002	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Summary of Benefits, H0482-002 - English (PDF)
Wellcare Complete - Giveback (HMO)	H0482- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Summary of Benefits, H0482-003 - English (PDF)

For HMO D SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare Complete Dual Access (HMO D-SNP)	H0482- 005	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Summary of Benefits, H0482-005 - 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)	H0482- 002	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Evidence of Coverage, H0482-002 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare Complete - Giveback (HMO)	H0482- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Evidence of Coverage, H0482-003 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage (EOC)

Wellcare Complete No Premium (HMO)

H0482- 002

Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne

Evidence of Coverage, H0482-002 - English (PDF)

Dental Benefit Details - English (PDF)

Wellcare Complete - Giveback (HMO)

H0482- 003

Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne

Evidence of Coverage, H0482-003 - English (PDF)

Dental Benefit Details - English (PDF)

For HMO D SNP Members:

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Wellcare Complete Dual Access (HMO D-SNP)	H0482- 005	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Evidence of Coverage, H0482-005 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage (EOC)

Wellcare Complete Dual Access (HMO D-SNP)

H0482- 005

Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne

Evidence of Coverage, H0482-005 - English (PDF)

Dental Benefit Details - English (PDF)

For HMO Members:

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Wellcare Complete No Premium (HMO)	H0482- 004 to H0482 -002	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H0482- 004 to H0482 -002 - English (PDF)
Wellcare Complete No Premium (HMO)	H0482- 002	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H0482-002 - English (PDF)
Wellcare Complete - Giveback (HMO)	H0482- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Annual Notice of Changes, H0482-003 - English (PDF)
Wellcare Complete - Giveback (HMO)	H0482- 001 to H0482 - 003	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H0482- 001 to H0482 - 003 - English (PDF)

For HMO DSNP Members:

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Wellcare Complete Dual Access (HMO D-SNP)	H0482- 005	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Annual Notice of Changes, H0482-005 - English (PDF)
Wellcare Complete Dual Access (HMO D-SNP)	H0482-006 to H0482-005	Arenac, Bay, Genesee, Iosco, Kalamazoo, Lapeer, Livingston, Macomb, Oakland, Saginaw, St. Clair, Tuscola, Wayne	Annual Notice of Changes, H0482-006 to H0482-005 - English (PDF)

Medicare Step Therapy Part B (PDF)

Covered Diabetes Testing Supplies

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Michigan Access Plus (PPO)	H7512- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H7512-001 - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H7512-002 - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Summary of Benefits, H7512-003 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 004	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Summary of Benefits, H7512-004 - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage (EOC)
Ascension Complete Michigan Access Plus (PPO)	H7512- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H7512-001 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Evidence of Coverage, H7512-002 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Evidence of Coverage, H7512-003 - English (PDF) Dental Benefit Details - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 004	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Evidence of Coverage, H7512-004 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete Michigan Access Plus (PPO)	H7512- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H7512-001 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Annual Notice of Changes, H7512-002 - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H7512-003 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 004	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Annual Notice of Changes, H7512-004 - English (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete Michigan Access Plus (PPO)	H7512- 001	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Welcome Kit, H7512-001 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 002	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Welcome Kit, H7512-002 - English (PDF)
Ascension Complete Michigan Access Plus (PPO)	H7512- 003	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Welcome Kit, H7512-003 - English (PDF)
Ascension Complete Michigan Access (PPO)	H7512- 004	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Welcome Kit, H7512-004 - English (PDF)

Michigan Plan Benefit Materials

For HMO Members:

For HMO D SNP Members:

For HMO Members:

For HMO D SNP Members:

Michigan Plan Benefit Materials

For HMO Members:

For HMO D SNP Members:

For PPO Members:

For HMO Members:

For HMO D SNP Members:

For PPO Members:

For HMO Members:

For HMO D SNP Members:

For PPO Members:

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Michigan Reward (HMO)	H0482- 001	Genesee, Iosco, KArenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Summary of Benefits, H0482-001 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 002	Arenac, Bay, Genesee, Iosco, Kalamazoo, Saginaw, Tuscola	Summary of Benefits, H0482-002 - English (PDF)
Ascension Complete Michigan Reward (HMO)	H0482- 003	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H0482-003 - English (PDF)
Ascension Complete Michigan Secure (HMO)	H0482- 004	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H0482-004 - English (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Michigan DSNP (HMO D-SNP)	H0482- 005	Genesee, Iosco, Kalamazoo, and Saginaw	Summary of Benefits, H0482-005 - English (PDF)
Ascension Complete Michigan DSNP (HMO D-SNP)	H0482- 006	Lapeer, Livingston, Macomb, Oakland, St. Clair, Wayne	Summary of Benefits, H0482-006 - English (PDF)

Michigan Plan Benefit Materials

Summary of Benefits (SB)

For HMO Members:

For HMO D SNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D SNP Members:

Annual Notice of Changes (ANOC)

Step Therapy Part B

Covered Diabetes Testing Supplies

Over-the-Counter (OTC) and Healthy Foods Catalogs

Michigan Plan Benefit Materials

Summary of Benefits

For HMO Members:

For HMO D SNP Members:

For PPO Members:

Evidence of Coverage (EOC)

For HMO Members:

For HMO D SNP Members:

For PPO Members:

Annual Notice of Changes (ANOC)

Step Therapy Part B

Addendum To 2023 Medicare Advantage Benefits

Welcome Kit

For HMO Members:

For HMO D SNP Members:

For PPO Members:

Over-the-Counter Catalog

Member Newsletter

Extra Benefits