On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare, or reach out to the contact center at 1-866-262-5342.
Plan Benefit Materials |
Plan Materials and Forms
Learn about your plan and all that it has to offer by reviewing helpful plan documents such as the Annual Notice of Change (ANOC), Summary of Benefits, and Evidence of Coverage.
To get started, locate your plan in the list of plans below and select “Plan Benefits.”
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 |
|---|---|---|---|
Wellcare No Premium (HMO) | H6550-003 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
Wellcare Assist (HMO) | H6550-006 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
Wellcare Giveback (HMO) | H6550-007 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For HMO D-SNP Members:
Plan Name | CMS# | County | Summary of Benefits |
|---|---|---|---|
Wellcare Dual Access (HMO D-SNP) | H6550-004 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
Wellcare Dual Liberty (HMO D-SNP) | H6550-009 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For PPO Members:
Plan Name | CMS# | County | Summary of Benefits |
|---|---|---|---|
Wellcare No Premium Open (PPO) | H9387-001 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
Wellcare Patriot Giveback Open (PPO) | H9387-002 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For PPO D-SNP Members:
Plan Name | CMS# | County | Summary of Benefits |
|---|---|---|---|
Wellcare Dual Access Open (PPO D-SNP) | H9387-004 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, 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 |
|---|---|---|---|
Wellcare No Premium (HMO) | H6550-003 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
Wellcare Assist (HMO) | H6550-006 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
Wellcare Giveback (HMO) | H6550-007 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For HMO D-SNP Members:
Plan Name | CMS# | County | Evidence of Coverage |
|---|---|---|---|
Wellcare Dual Access (HMO D-SNP) | H6550-004 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
Wellcare Dual Liberty (HMO D-SNP) | H6550-009 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
|
For PPO Members:
Plan Name | CMS# | County | Evidence of Coverage |
|---|---|---|---|
Wellcare No Premium Open (PPO) | H9387-001 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
Wellcare Patriot Giveback Open (PPO) | H9387-002 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For PPO D-SNP Members:
Plan Name | CMS# | County | Evidence of Coverage |
|---|---|---|---|
Wellcare Dual Access Open (PPO D-SNP) | H9387-004 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, 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 Change |
|---|---|---|---|
| Wellcare No Premium (HMO) | H6550-003 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Assist (HMO) | H6550-006 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Giveback (HMO) | H6550-007 | AAllen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For HMO D-SNP Members:
| Plan Name | CMS# | County | Annual Notice of Change |
|---|---|---|---|
| Wellcare Dual Access (HMO D-SNP) | H6550-004 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Dual Liberty (HMO D-SNP) | H6550- 009 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For PPO and PPO D-SNPMembers:
| Plan Name | CMS# | County | Annual Notice of Change |
|---|---|---|---|
| Wellcare No Premium Open (PPO) | H9387-001 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Patriot Giveback Open (PPO) | H9387-002 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Dual Access Open (PPO D-SNP) | H9387-004 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |