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Benefit Information

WellCare provides certain benefits and services specified by federal requirements for health plans administering to Medicaid members.

  1. WellCare allows women direct access to in-network women's health specialists for covered routine and preventive health care services.
  2. WellCare provides for a second opinion from an in-network provider or arranges for the member to obtain a second opinion outside the network.
  3. 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.
  4. 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. 
  5. WellCare requires the hours of operation that providers offer to Medicaid members to be no less than those offered to commercial members.


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Last Updated On: 12/3/2020