Wellcare Value Script (PDP)

Notice of Availability of Language Assistance Services and Auxiliary Aids and Services

If you speak a language other than English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-877-374-4056 (TTY: 711).

• Multi Language

Electronic Funds Transfer

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

• English
• Spanish

Prescription Drug Claim Form

Complete this form to request reimbursement/refund for covered prescription drugs that you paid full price for.

• English

Member Disenrollment Form

Each member requesting to be disenrolled must complete their own form.

• English
• Spanish coming soon