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.