WellCare provides certain benefits and services specified by federal requirements for health plans administering to Medicaid members.
- WellCare allows women direct access to in-network women's health specialists for covered routine and preventive health care services.
- WellCare provides for a second opinion from an in-network provider or arranges for the member to obtain a second opinion outside the network.
- If WellCare is unable to provide a necessary and covered service to a member in-network, WellCare must adequately and timely cover these services out-of-network, for as long as WellCare is unable to provide these services.
- If WellCare approves a member to go out-of-network because it is unable to provide a necessary and covered service in-network, WellCare coordinates payment with the out-of-network provider and ensures that the cost to the member is no greater than it would be if the services were furnished in-network.
- WellCare requires the hours of operation that providers offer to Medicaid members to be no less than those offered to commercial members.