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 Medicare (HMO)	H7173-002	Chattahoochee, Clayton, DeKalb, Douglas, Fayette, Fulton, Greene, Gwinnett, Harris, Henry, Morgan, Muscogee, Oconee, Paulding, Rockdale, Spalding and Troup	Summary of Benefits, H7173-002 - English (PDF) Summary of Benefits, H7173-002 - Korean (PDF) Summary of Benefits, H7173-002 - Spanish (PDF)
Wellcare Giveback Medicare (HMO)	H7173 - 007	DeKalb, Fulton, Greene, Gwinnett and Muscogee	Summary of Benefits, H7173-007 - English (PDF) Summary of Benefits, H7173-007 - Korean (PDF) Summary of Benefits, H7173-007 - Spanish (PDF)

Plan Name

CMS#

County

Summary of Benefits

Wellcare No Premium Medicare (HMO)

H7173-002

Chattahoochee, Clayton, DeKalb, Douglas, Fayette, Fulton, Greene, Gwinnett, Harris, Henry, Morgan, Muscogee, Oconee, Paulding, Rockdale, Spalding and Troup

Summary of Benefits, H7173-002 - Spanish (PDF)

Wellcare Giveback Medicare (HMO)

H7173 - 007

DeKalb, Fulton, Greene, Gwinnett and Muscogee

For HMO D-SNP Members:

Plan Name	CMS#	County	Summary of Benefits
Wellcare Dual Access Medicare (HMO D-SNP)	H7173-001	Butts, Chattahoochee, Clayton, Cobb, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton, Greene, Gwinnett, Harris, Heard, Henry, Lumpkin, Marion, Morgan, Muscogee, Oconee, Paulding, Pickens, Rockdale, Spalding, Taliaferro, Troup	Summary of Benefits, H7173-001 - English (PDF) Summary of Benefits, H7173-001 - Korean (PDF) Summary of Benefits, H7173-001 - Spanish (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
Wellcare No Premium Medicare (HMO)	H7173-002	Chattahoochee, Clayton, DeKalb, Douglas, Fayette, Fulton, Greene, Gwinnett, Harris, Henry, Morgan, Muscogee, Oconee, Paulding, Rockdale, Spalding and Troup	Evidence of Coverage, H7173-002 - English (PDF) Evidence of Coverage, H7173-002 - Spanish (PDF) Evidence of Coverage, H7173-002 - Korean (PDF)
Wellcare Giveback Medicare (HMO)	H7173-007	DeKalb, Fulton, Greene, Gwinnett and Muscogee	Evidence of Coverage, H7173-007 - English (PDF) Evidence of Coverage, H7173-007 - Spanish (PDF) Evidence of Coverage, H7173-007 - Korean (PDF)

Plan Name

CMS#

County

Evidence of Coverage

Wellcare No Premium Medicare (HMO)

H7173-002

Chattahoochee, Clayton, DeKalb, Douglas, Fayette, Fulton, Greene, Gwinnett, Harris, Henry, Morgan, Muscogee, Oconee, Paulding, Rockdale, Spalding and Troup

Evidence of Coverage, H7173-002 - English (PDF)

Wellcare Giveback Medicare (HMO)

H7173-007

DeKalb, Fulton, Greene, Gwinnett and Muscogee

Evidence of Coverage, H7173-007 - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Evidence of Coverage
Wellcare Dual Access Medicare (HMO D-SNP)	H7173-001	Butts, Chattahoochee, Clayton, Cobb, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton, Greene, Gwinnett, Harris, Heard, Henry, Lumpkin, Marion, Morgan, Muscogee, Oconee, Paulding, Pickens, Rockdale, Spalding, Taliaferro, Troup	Evidence of Coverage, H7173-001 - English (PDF) Evidence of Coverage, H7173-001 - Spanish (PDF) Evidence of Coverage, H7173-001 - Korean (PDF)

If you were enrolled in a plan 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 Name	CMS#	County	Annual Notice Of Changes (ANOC)
Wellcare No Premium Medicare (HMO)	H7173-002	Chattahoochee, Clayton, DeKalb, Douglas, Fayette, Fulton, Greene, Gwinnett, Harris, Henry, Morgan, Muscogee, Oconee, Paulding, Rockdale, Spalding and Troup	Annual Notice of Changes, H7173-002 - English (PDF) Annual Notice of Changes, H7173-003-002 - Spanish (PDF)
Wellcare Giveback Medicare (HMO)	H7173-007	DeKalb, Fulton, Greene, Gwinnett and Muscogee	Annual Notice of Changes, H7173-007 - English (PDF) Annual Notice of Changes, H7173-007 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Annual Notice of Changes (ANOC)
Wellcare Dual Access Medicare (HMO D-SNP)	H7173-001	Butts, Chattahoochee, Clayton, Cobb, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton, Greene, Gwinnett, Harris, Heard, Henry, Lumpkin, Marion, Morgan, Muscogee, Oconee, Paulding, Pickens, Rabun, Rockdale, Spalding, Taliaferro, Towns, Troup, Union and White	Annual Notice of Changes, H7173-001 - English (PDF) Annual Notice of Changes, H7173-001 - Spanish (PDF)

Need help at the doctor's office?

Visiting the doctor’s office can be difficult when you are trying to remember the details of your medical needs and health concerns over a period of time. With the amount of paperwork to fill out and questions to answer, it can be hard to make sure you are able to tell your doctor exactly what the problems are.

Don’t wait until you get to the doctor’s office to start thinking of the reasons for your appointment. Try these helpful doctor visit guides from [MEDICARE_NAME] to learn what to expect and prepare to ask your own questions about your medications, treatment options, warning signs, health tips and diet needs.

These helpful guides include details about common medical issues, so you’ll be ready to talk to your doctor about your issue, find out the information you need, and better understand what to expect from your visit.

Click on any of the forms listed below
Print out the form you need
Fill in the answers before your appointment
Take it with you to the doctor

These helpful doctor visit guides can be useful when you're being seen for any of the following conditions:

Plan Name	CMS#	County	Annual Notice of Changes
Allwell Medicare (HMO)	H7173-002	Chattahoochee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Greene, Gwinnett, Harris, Henry, Morgan, Muscogee, Oconee, Paulding, Rockdale, Spalding and Troup counties	Annual Notice of Change, H7173-002 - English (PDF)
Allwell Medicare Premier (HMO)	H7173-007	DeKalb, Fulton, Greene, Gwinnett and Muscogee counties	Annual Notice of Change, H7173-007 - English (PDF) Annual Notice of Change, H7173-007 - Spanish (PDF)
Allwell Medicare (HMO)	H7173-008-002	Butts, Chattahoochee, Clayton, Cobb, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton, Greene, Gwinnett, Harris, Heard, Henry, Lumpkin, Marion, Morgan, Muscogee, Oconee, Paulding, Pickens, Rockdale, Spalding, Taliaferro and Troup counties	Annual Notice of Change, H7173-008-002 - English (PDF)

Plan Benefit Materials |

Plan Materials and Forms

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For HMO D-SNP Members:

Plan Benefit Materials

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

Plan Benefit Materials |

Plan Materials and Forms

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)

For HMO D-SNP Members:

Doctor Visit Forms

Over-The-Counter Benefits

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)

For HMO Members:

For HMO D-SNP Members: