Plan Benefit Materials |

Plan Materials and Forms

 

Information about plan benefits, services, and drug costs can be found in your plan materials.

Look at your Allwell from Peach State Health Plan member ID card for your plan number and type to view materials for your plan. 

  • View a sample of an 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 Allwell from Peach State Health Plan 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

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, Rabun, Rockdale, Spalding, Taliaferro, Towns, Troup, Union and White

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)
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, Rabun, Rockdale, Spalding, Taliaferro, Towns, Troup, Union and White

  • Evidence of Coverage, H7173-001 - English (PDF)

If you were enrolled in [2020_PLAN_FULL] 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
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
Wellcare Giveback Medicare (HMO) H7173-007 DeKalb, Fulton, Greene, Gwinnett and Muscogee

For HMO D-SNP Members:  

Plan Name CMS# County  Annual Notice of Changes
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

Your current plan may have an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. This catalog includes a list of OTC items that you can order to be mailed to your home. Check the catalog for item limits.

Ordering is easy. Just follow the steps in your plan's catalog.

Don't want to wait? You may be able to pick up your OTC products from a CVS store near you. Please note: this does not include CVS locations inside of Target stores.

Connect to the CVS OTC website to view available products and store information.

 

Material ID: Y0020_20_17590WEB_C_03192020

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.

  1. Click on any of the forms listed below
  2. Print out the form you need
  3. Fill in the answers before your appointment
  4. 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: