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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 is offered exclusively to enrollees with both Medicare and Medicaid eligibility. It provides coverage for all Medicare-covered Part A and Part B services received from network providers as well as prescription drugs. The plan may also cover supplemental, non-Medicare covered services such as routine dental, vision and hearing care.

Annual Notice of Change (ANOC)

This document (the "Annual Notice of Change") includes any changes in coverage, costs, or service area between your 2016 and 2017 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.

Star Ratings judge how well Medicare health and drug plans perform in different categories. They are distributed by Medicare. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

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

Use this form to enroll in a Medicare Advantage plan.

Formulary

This document shows you what drugs are covered by a specific plan.

This document is a listing of the changes that have occurred in our formulary in the past month.

Related Materials

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.

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.

Helpful Information

24-Hour Nurse Advice Line

One of the benefits of being a WellCare member is our 24-Hour Nurse Advice Line. Our nurses will give you answers to your medical questions and help you decide whether to see your doctor or go to the emergency room. Nurses are available 24 hours a day, seven days a week at 1-800-581-9952. (TTY users dial 711.)

Surgery Assistance

If you or a loved one had to have surgery, would you know what to do first?
One question in many people's minds is, "Do I need surgery, or is there another option?"

Introducing Welvie® - an online surgery decision-support program that you can use with your doctor to decide on, prepare for and recover after surgery. And it is available at no extra cost to you.

You are six steps away from better results.
Welvie has broken down your surgery journey into six simple steps that take you from diagnosis to recovery:

Step 1 - Get the right diagnosis

Step 2 - Find the right doctor

Step 3 - Make a treatment decision

Step 4 - Learn about hospitals

Step 5 - Prepare for surgery

Step 6 - Recover at home

It pays to know Welvie.
For current WellCare members only: After you complete the first three steps of the Welvie program, you will receive a $25 amazon.com gift card. Even if you are not considering surgery right now, be sure to check out Welvie so if you are faced with making a surgery decision in the future, you will be prepared.

Take me to Welvie

  • 24 Hour Nurse Advice Line

    24-Hour Nurse Advice Line

    One of the benefits of being a WellCare member is our 24-Hour Nurse Advice Line. Our nurses will give you answers to your medical questions and help you decide whether to see your doctor or go to the emergency room. Nurses are available 24 hours a day, seven days a week at 1-800-581-9952. (TTY users dial 711.)
  • Surgery Decision Assistance

    Surgery Assistance

    If you or a loved one had to have surgery, would you know what to do first?
    One question in many people's minds is, "Do I need surgery, or is there another option?"

    Introducing Welvie® - an online surgery decision-support program that you can use with your doctor to decide on, prepare for and recover after surgery. And it is available at no extra cost to you.

    You are six steps away from better results.
    Welvie has broken down your surgery journey into six simple steps that take you from diagnosis to recovery:

    Step 1 - Get the right diagnosis

    Step 2 - Find the right doctor

    Step 3 - Make a treatment decision

    Step 4 - Learn about hospitals

    Step 5 - Prepare for surgery

    Step 6 - Recover at home

    It pays to know Welvie.
    For current WellCare members only: After you complete the first three steps of the Welvie program, you will receive a $25 amazon.com gift card. Even if you are not considering surgery right now, be sure to check out Welvie so if you are faced with making a surgery decision in the future, you will be prepared.

    Take me to Welvie


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Last Updated On: 10/1/2017