Plan Benefit Materials |

Plan Materials and Forms

 

Listed below are some documents that may be helpful at different times during your membership. 

This booklet gives you a summary of costs and coverage in your plan. 

Please select the document for your plan and county:

For HMO Members:

Plan Name  CMS# County Summary of Benefits
Allwell Medicare (HMO) H6550-001 Johnson, Leavenworth, Miami and Wyandotte counties
Allwell Medicare (HMO) H6550-003 Allen, Bourbon, Cherokee, Crawford, Douglas, Johnson, Leavenworth, Linn, Miami, Sumner, Woodson, and Wyandotte counties


For HMO D-SNP Members:

Plan Name  CMS# County Summary of Benefits
Allwell Dual Medicare (HMO D-SNP) H6550-004 Cherokee, Crawford, Johnson, Leavenworth, Miami, Sedgwick and Wyandotte counties

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:

For HMO Members:

Plan Name  CMS# County Evidence of Coverage
Allwell Medicare (HMO) H6550-001 Johnson, Leavenworth, Miami and Wyandotte counties
Allwell Medicare (HMO) H6550-003 Allen, Bourbon, Cherokee, Crawford, Douglas, Johnson, Leavenworth, Linn, Miami, Sumner, Woodson, and Wyandotte counties


For HMO D-SNP Members:

Plan Name  CMS# County Evidence of Coverage
Allwell Dual Medicare (HMO D-SNP) H6550-004 Cherokee, Crawford, Johnson, Leavenworth, Miami, Sedgwick and Wyandotte counties

This booklet will tell you about changes to your plan’s costs and benefits for the coming year.

Please select the document for your plan and county:

For HMO Members:

Plan Name  CMS# County Annual Notice of Change
Allwell Medicare (HMO) H6550-001 Johnson, Leavenworth, Miami and Wyandotte counties
Allwell Medicare (HMO) H6550-003 Allen, Bourbon, Cherokee, Crawford, Douglas, Johnson, Leavenworth, Linn, Miami, Sumner, Woodson, and Wyandotte counties


For HMO D-SNP Members:

Plan Name  CMS# County Annual Notice of Change
Allwell Dual Medicare (HMO D-SNP) H6550-004 Cherokee, Crawford, Johnson, Leavenworth, Miami, Sedgwick and Wyandotte counties

Your current plan may have an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. This catalog includes a list of OTC items that you can order to be mailed to your home. Check the catalog for item limits.

Ordering is easy. Just follow the steps in your plan's catalog.