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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, Wyandotte
Allwell Medicare (HMO) H6550-003 Cherokee, Crawford, Sedgwick


For HMO SNP Members:

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

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, Wyandotte
Allwell Medicare (HMO) H6550-003 Cherokee, Crawford, Sedgwick


For HMO SNP Members:

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

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 Changes
Allwell Medicare (HMO) H6550-001 Johnson, Leavenworth, Miami 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 Low Income Subsidy
Allwell Medicare (HMO) H6550-001 Johnson, Leavenworth, Miami, Wyandotte
Allwell Medicare (HMO) H6550-003 Cherokee, Crawford, Sedgwick

For HMO SNP Members:

Plan Name  CMS# County Low Income Subsity
Allwell Medicare (HMO) H6550-004 Cherokee, Crawford, Johnson, Leavenworth. Miami, Sedgwick, Wyandotte

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

Ordering is easy! Just follow the steps listed on your plan's catalog.

  • Appointing a Representative (PDF)
    • Use this form to name a person to act as your representative. Must be completed by you and accepted by the person you appoint.
  • PHI Authorization Form (PDF)
    • Use this form when you want to allow Allwell to share your health information with a person or group.
  • PHI Revocation Form (PDF)
    • Use this form when you want Allwell to cancel or revoke your previous permission to share health information with a person or group
  • Beginner's Guide to Medicare Booklet (PDF) 
    Important choices can be simple choices. So let us help! Take a look at the below Beginner's Guide to Medicare booklet. Our Medicare guide will give you a solid foundation for understanding the basics of Medicare and available options you have as a new Medicare beneficiary. If you have any questions or need assistance, call us. We are here to help!

This is an introduction to the provider and pharmacy directory, including an explanation of the provider symbols found in the directory.

Visit our Find a Doctor or Pharmacy page to learn more. 

  • Best Available Evidence (BAE)
    • This is a CMS policy that allows for changes to cost-sharing for low-income beneficiaries when there is evidence that information from a beneficiary is not up-to-date or accurate.

medicare phone number

 

Can't find what you need? Contact Member Services. We are here to help!