Thank you for being a loyal customer of WellCare Health Plans.  On this page you will be able to quickly find all the forms that you as a member will need. To view an online version of your summary of benefits or evidence of coverage please click on the Our Plans tab at the end of this paragraph.  You will be prompted to select your state and county that you live in.  Once you make that selection please choose the plan that you are enrolled in by clicking on the words View Details to the right of the Plan Name.  The page will refresh itself and then you can scroll to the bottom of the page to find a link to the Evidence of Coverage or the Summary of Benefits.

Member Newsletter (pdf link)

Fitness and HealthStuff (Over-the-Counter Items) 

HealthStuff (Over-the-Counter Items) Claim Form -2009 (PDF Listing)

Non-Participating Fitness Center Claim Form -2009 (PDF Listing)

To access your HealthStuff (Over-the-Counter Items) reimbursement information click here: Reimbursement Tracker

Provider Directories

Dental, Vision and Hearing Providers- 2009 (PDF Listing)

Primary Care Physician Providers - Arkansas 2009 (PDF Listing) or California 2009

To find a dental, vision, or hearing provider near you please click here: Find A Provider

Coverage Determination Forms

Prescription Drug Extra Help Checklist

Redetermination Request Form

Reconsideration Request Form

Appointment of Representation Form

Prescription Drug Forms and Formulary

Prescription Drug Coverage Determination Request Form

Injectable/Infusion Prescription Order Form

Provider Pharmacy Appeal Form

Prescription Drugs Direct Member Reimbursement Form

Formulary- 2008 (PDF Listing)

Formulary Update - 2008 (PDF Listing)

Formulary - 2009 (PDF Listing)

Formulary Update - 2009 (PDF Listing) 

To locate a pharmacy near you click on the Pharmacy tab at the top of the page.

Have your premium deducted directly from your checking account by filling out the Electronic Funds Transfer form.