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Thank you for being a WellCare member!

Here you can quickly get to the documents and forms that are specific to your plan.

This plan provides coverage for all Medicare-covered Part A and Part B services received from network providers, in addition to prescription drugs.

Annual Notice of Change (ANOC)

This document (the "Annual Notice of Change") includes any changes in coverage, costs, or service area between your 2019 and 2020 plan.

This document includes any changes in coverage, costs or service area between your previous and current plan year.

Plan Specific Documents

This document provides some of the features of this plan. For a complete list of benefits, see your Evidence of Coverage.

This document includes a legal, detailed description of your benefits and costs as a member.

Use this form to authorize us to withdraw your monthly premiums from your bank.

Use this form to enroll in a Medicare Advantage plan.

If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly plan premium as a member of our Plan.

Related Materials

Use this form to enroll in a Medicare Advantage plan.

Complete this form to request reimbursement for covered medical services that you paid for out of pocket.

Use this claim form to be reimbursed for eligible over-the-counter items. Please submit one form per member.

Use this form to authorize us to withdraw your monthly premiums from your bank.

This is a sample of what an Explanation of Benefits looks like. It details any prescriptions covered in a specific month, what your plan paid and what you paid.

This document includes information about multi-language interpreter services for speakers of Arabic, Chinese Cantonese, Chinese Mandarin, French Creole, French, German, Hindi, Italian, Japanese, Korean, Polish, Portuguese, Russian, Spanish, Tagalog, and Vietnamese.

This form confirms your request for a particular person to act as your representative in connection with a claim.

This form confirms you are the court-appointed legal guardian, have power of attorney or are able to make medical decisions on another person’s behalf.

This form confirms your permission that WellCare may discuss or disclose Protected Health Information (PHI) with a particular person.

This form revokes your permission for WellCare to discuss or disclose Protected Health Information (PHI) with a particular person.

Important Information

For important information about WellCare’s Medicare Advantage coverage including eligibility, benefits and more, please see our Conditions and Limitations page.

You have the right to file a grievance or provide feedback directly to Medicare about our plan. Complete and submit the Medicare Feedback and Complaint Form.

Medicare has an Office of the Medicare Ombudsman (OMO) that can help you with complaints, grievances and information requests. Visit Medicare.gov for more information about Medicare and/or assistance with complaints and grievances.

WellCare (HMO) is a Medicare Advantage organization with a Medicare contract. Enrollment in WellCare (HMO) depends on contract renewal.

You must continue to pay your Medicare Part B premium.

How to access coverage in the event of a disaster or local emergency.

In the event of an emergency or natural disaster, WellCare is committed to helping you continue to access care easily. In a time of crisis, we will:

  • Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A and Part B benefits must, per 42 CFR §422.204(b)(3), be furnished at Medicare certified facilities)
  • Waive in full, requirements for gatekeeper referrals where applicable
  • Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing amounts
  • Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the enrollee
  • Allow you to fill medications sooner than usual to ensure you have what you need during the emergency 

These actions will be in effect through the emergency declaration period. Disasters/Emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or the Governor of any state.

Typically, the source which declares the disaster will clarify when the disaster or emergency is over. If however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration.

WellCare also offers Special Needs Plans (SNP) to qualifying individuals. To enroll in a Special Needs Plan, please contact us for more information.

  • Disclaimers

    For important information about WellCare’s Medicare Advantage coverage including eligibility, benefits and more, please see our Conditions and Limitations page.

    You have the right to file a grievance or provide feedback directly to Medicare about our plan. Complete and submit the Medicare Feedback and Complaint Form.

    Medicare has an Office of the Medicare Ombudsman (OMO) that can help you with complaints, grievances and information requests. Visit Medicare.gov for more information about Medicare and/or assistance with complaints and grievances.

    WellCare (HMO) is a Medicare Advantage organization with a Medicare contract. Enrollment in WellCare (HMO) depends on contract renewal.

    You must continue to pay your Medicare Part B premium.

  • How to access coverage in the event of a disaster or local emergency.

    How to access coverage in the event of a disaster or local emergency.

    In the event of an emergency or natural disaster, WellCare is committed to helping you continue to access care easily. In a time of crisis, we will:

    • Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A and Part B benefits must, per 42 CFR §422.204(b)(3), be furnished at Medicare certified facilities)
    • Waive in full, requirements for gatekeeper referrals where applicable
    • Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing amounts
    • Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the enrollee
    • Allow you to fill medications sooner than usual to ensure you have what you need during the emergency 

    These actions will be in effect through the emergency declaration period. Disasters/Emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or the Governor of any state.

    Typically, the source which declares the disaster will clarify when the disaster or emergency is over. If however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration.

  • Special Needs

    WellCare also offers Special Needs Plans (SNP) to qualifying individuals. To enroll in a Special Needs Plan, please contact us for more information.


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Y0070_WCM_42183E Last Updated On: 10/1/2019