Plan Benefit Materials |

Plan Materials and Forms

 

Information about plan benefits, services, and drug costs can be found in your plan materials.

Look at your Allwell from Arizona Complete Health member ID card for your plan number and type to view materials for your plan. 

You can also look for plan materials based on the plan name and the county you live in.

If you don’t have a Allwell from Arizona Complete Health ID card or have questions about plan materials, give us a call. We’re here to help.

For HMO Members

Plans CMS# County Summary of Benefits
Allwell Medicare (HMO) H0351 - 044-001
  • Pima
Allwell Medicare (HMO) H0351 - 044-002
  • Cochise
Allwell Medicare Premier (HMO) 

H9287 - 001

  • Pima
Allwell Medicare Essentials II (HMO) H0351 - 050
  • Maricopa and Pinal
Allwell Medicare Premier (HMO) H0351 - 051
  • Maricopa and Pinal
Allwell Medicare Essentials I (HMO) H5590 - 007
  • Cochise, Maricopa, Pima, Pinal, Santa Cruz, Yuma
Allwell Medicare Essentials (HMO) H5590 - 005
  • Maricopa and Pinal
Allwell Medicare
H5590 - 004
  • Yuma


For HMO D-SNP Members

Plans  CMS# County Summary of Benefits
Allwell Dual Medicare  (HMO D-SNP)  H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz,
    Pinal, Maricopa, Pima, Santa Cruz and Yuma
Allwell CHF/Diabetes Medicare (HMO C-SNP)  H0351 - 038
  • Maricopa and Pinal

For HMO Members

Plans CMS# County Evidence Of Coverage
Allwell Medicare (HMO) H0351 - 044-001
  • Pima
Allwell Medicare (HMO) H0351 - 044-002
  • Cochise, Santa Cruz
Allwell Medicare Essentials II (HMO)  H0351 - 050
  • Maricopa, Pinal
Allwell Medicare Premier (HMO)  H0351 - 051
  • Maricopa, Pinal
Allwell Medicare Premier (HMO) 

H9287 - 001

  • Pima
Allwell Medicare (HMO) H5590 - 004
  • Yuma, Yavapai
Allwell Medicare Essentials (HMO)

H5590 - 005

  • Maricopa, Pinal  
Allwell Medicare Essentials I (HMO) H5590 - 007
  • Cochise, Maricopa, Pima, Pinal, Santa Cruz and Yuma

 

For HMO D-SNP Members

Plans  CMS# County Evidence Of Coverage
Allwell Dual Medicare (HMO D-SNP) H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz and Yuma
Allwell CHF/Diabetes Medicare (HMO C-SNP)  H0351 - 038
  • Maricopa, Pinal

For HMO Members

Plans CMS# County Annual Notice Of Changes
Allwell Medicare (HMO)

H0351 - 044-001

 

  • Pima
Allwell Medicare (HMO) H0351 - 044-002
  • Cochise and Santa Cruz

 

Allwell Medicare Premier (HMO)  H0351 - 051
  • Maricopa
  • Pinal
Allwell Medicare Premier (HMO) 

H9287 - 001

  • Pima
Allwell Medicare Essentials II (HMO) H0351 - 050
  • Maricopa
  • Pinal
Allwell Medicare (HMO) H5590 - 004
  • Yavapai
Allwell Medicare Essentials (HMO)

H5590 - 005

  • Cochise, Maricopa, Pima, Santa Cruz and Yuma


For HMO D-SNP Members

Plans  CMS# County Annual Notice Of Changes
Allwell CHF/Diabetes Medicare (HMO C-SNP)  H0351 - 038
  • Maricopa, Pinal
Allwell Dual Medicare (HMO D-SNP) H5590-006-001 and H5590 - 006-002
  • Maricopa, Pima, Yuma

 

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.

Don’t want to wait? You may be able to pick up your OTC products from a CVS store near you. Please note: this does not include CVS locations inside of Target stores.

Connect to the CVS OTC website to view available products and store information.

 

Material ID: Y0020_20_17590WEB_C_03192020