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Members : Forms
Coverage Determination Forms
- Medicare Part D Coverage Determination Request Form
(Provider) - WellCare Coverage Determination Request Form (Provider)
- Request for Medicare Prescription Drug Coverage Determination Form (Member)
- Medicare Redetermination Request Form
- Appointment of Representative Form
Prescription Drug Forms
- WellCare Injectable Infusion Form
- WellCare Medication Appeal Request Form
- Direct Member Part D Reimbursement Form
- Transition Policy Information: English, Spanish, Chinese or Russian
HealthStuff (Over-the-Counter Items)
Miscellaneous Forms & Information
- Electronic Funds Transfer Form
- Hospital Rights Form ( English orSpanish)
- Plan Rating
Last modified: 06/24/2010
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