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Plan Benefit Materials | Allwell from MHS Health Wisconsin
Plan Materials and Forms
Learn about your plan and all that it has to offer by reviewing helpful plan documents such as the Annual Notice of Change (ANOC), Summary of Benefits, and Evidence of Coverage.
To get started, locate your plan in the list of plans below and select “Plan Benefits.”
This booklet gives you a summary of costs and coverage in your plan.
Please select the document for your plan and county:
For HMO D-SNP Members:
| 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 | |
Wellcare All Dual Assure (HMO D-SNP) | H8189-007 | 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:
| Plan Name | CMS# | County | Evidence of Coverage |
|---|---|---|---|
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 | |
Wellcare All Dual Assure (HMO D-SNP) | H8189-007 | 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 |
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 |