Plan Benefit Materials | Allwell from MHS Health Wisconsin

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:

Plan Name CMS# County Summary of Benefits
Wellcare Dual Access (HMO D-SNP) H8189-001

Adams, Brown, Calumet, Clark, Columbia, Dane, Dodge, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

For HMO D-SNP Members:  

  • 2022 Medicare Defined Cost Sharing Amounts Notice (PDF) - coming soon
Plan Name CMS# County  Evidence of Coverage
Wellcare Dual Access (HMO D-SNP) DSNP H8189-001

Adams, Brown, Calumet, Clark, Columbia, Dane, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, and Wood counties

If you were enrolled in Allwell from MHS Health Wisconsin 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 D-SNP Members:  

Plan Name CMS# County  Annual Notice Of Changes
Wellcare Dual Access (HMO D-SNP) DSNP H8189-001

Adams, Brown, Calumet, Clark, Columbia, Dane, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, and Wood counties