Plan Benefit Materials | Allwell at Arizona Complete Health

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. 

  • View a sample of an Allwell Member ID Card to see where this information is located.

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
Wellcare No Premium (HMO) H0351 - 052
  • Maricopa, Pima, Pinal, Yavapai
  • Summary of Benefits, H0351 - 052 - English (PDF)
  • Summary of Benefits, H0351 - 052 - Spanish (PDF)
Wellcare No Premium (HMO) H0351 - 053
  • Cochise, Mohave, Santa Cruz, Yuma
  • Summary of Benefits, H0351 - 053 - English (PDF)
  • Summary of Benefits, H0351 - 053 - Spanish (PDF)
Wellcare Giveback (HMO) H0351 - 054
  • Cochise, Mohave, Santa Cruz, Yuma
  • Summary of Benefits, H0351 - 054 - English (PDF)
  • Summary of Benefits, H0351 - 054 - Spanish (PDF)
Wellcare Assist (HMO) H0351 - 055
  • Maricopa, Pima, Pinal, Yavapai
  • Summary of Benefits, H0351 - 055 - English (PDF)
  • Summary of Benefits, H0351 - 055 - Spanish (PDF)
Wellcare Giveback (HMO) H0351 - 056
  • Maricopa, Pima, Pinal, Yavapai
  • Summary of Benefits, H0351 - 056 - English (PDF)
  • Summary of Benefits, H0351 - 056 - Spanish (PDF)
Wellcare No Premium Essentials (HMO) H5590-0005
  • Maricopa and Pinal
  • Summary of Benefits, H5590 - 005 - English (PDF)

  • Summary of Benefits, H5590 - 005 - Spanish (PDF)
Wellcare Assist (HMO) H5590 - 007
  • Cochise, Mohave, Santa Cruz, Yuma


For HMO D-SNP Members

Plans  CMS# County Summary of Benefits
Wellcare Dual Liberty (HMO D-SNP) H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yuma
Wellcare Dual Liberty (HMO D-SNP) H5590 - 009
  • Apache, Coconino, Mohave, Navajo, Yavapai
  • Summary of Benefits, H5590 - 009 - English (PDF)

  • Summary of Benefits, H5590 - 009 - Spanish (PDF)
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 038
  • Maricopa, Pima and Pinal
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 057
  • Cochise, Mohave, Santa Cruz, Yavapai, Yuma
  • Summary of Benefits, H0351 - 057 - English (PDF)
     
  • Summary of Benefits, H0351 - 057 - Spanish (PDF)


For HMO Members

Plans CMS# County Evidence of Coverage
Wellcare No Premium (HMO) H0351 - 052
  • Maricopa, Pima, Pinal, Yavapai
  • Evidence of Coverage, H0351 - 052 - English (PDF)
  • Evidence of Coverage, H0351 - 052 - Spanish (PDF)
Wellcare No Premium (HMO) H0351 - 053
  • Cochise, Mohave, Santa Cruz, Yuma
  • Evidence of Coverage, H0351 - 053 - English (PDF)
  • Evidence of Coverage, H0351 - 053 - Spanish (PDF)
Wellcare Giveback (HMO) H0351 - 054
  • Cochise, Mohave, Santa Cruz, Yuma
  • Evidence of Coverage, H0351 - 054 - English (PDF)
  • Evidence of Coverage, H0351 - 054 - Spanish (PDF)
Wellcare Assist (HMO) H0351 - 055
  • Maricopa, Pima, Pinal, Yavapai
  • Evidence of Coverage, H0351 - 055 - English (PDF)
  • Evidence of Coverage, H0351 - 055 - Spanish (PDF)
Wellcare Giveback (HMO) H0351 - 056
  • Maricopa, Pima, Pinal, Yavapai
  • Evidence of Coverage, H0351 - 056 - English (PDF)
  • Evidence of Coverage, H0351 - 056 - Spanish (PDF)
Wellcare No Premium Essentials (HMO) H5590-0005
  • Maricopa and Pinal
  • Evidence of Coverage, H5590 - 005 - English (PDF)

  • Evidence of Coverage, H5590 - 005 - Spanish (PDF)
Wellcare Assist (HMO) H5590 - 007
  • Cochise, Mohave, Santa Cruz, Yuma
  • Evidence of Coverage, H5590 - 007 - English (PDF)

  • Evidence of Coverage, H5590 - 007 - Spanish (PDF)


For HMO D-SNP Members

Plans  CMS# County Evidence of Coverage
Wellcare Dual Liberty (HMO D-SNP) H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yuma
  • Evidence of Coverage, H5590 - 008 - English (PDF)

  • Evidence of Coverage, H5590 - 008 - Spanish (PDF)
Wellcare Dual Liberty (HMO D-SNP) H5590 - 009
  • Apache, Coconino, Mohave, Navajo, Yavapai
  • Evidence of Coverage, H5590 - 009 - English (PDF)

  • Evidence of Coverage, H5590 - 009 - Spanish (PDF)
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 038
  • Maricopa, Pima and Pinal
  • Evidence of Coverage, H0351 - 038 - English (PDF)
     
  • Evidence of Coverage, H0351 - 038 - Spanish (PDF)
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 057
  • Cochise, Mohave, Santa Cruz, Yavapai, Yuma
  • Evidence of Coverage, H0351 - 057 - English (PDF)
     
  • Evidence of Coverage, H0351 - 057 - Spanish (PDF)


For PPO Members

Plans  CMS# County Evidence of Coverage
Wellcare No Premium Open (PPO) H8553 - 001
  • Maricopa, Pima
  • Evidence of Coverage, H8553 - 001 - English (PDF)

Wellcare Patriot Giveback Open (PPO) H8553 - 002
  • Maricopa, Pima
  • Evidence of Coverage, H8553 - 002 - English (PDF)

Wellcare No Premium Rx Plus Open (PPO) H8553 - 003
  • Maricopa, Pima
  • Evidence of Coverage, H8553 - 003 - English (PDF)

 


For HMO Members

Plans CMS# County Annual Notice of Changes
Wellcare No Premium (HMO) H0351 - 052
  • Maricopa, Pima, Pinal, Yavapai
  • Annual Notice of Changes, H0351 - 052 - English (PDF)
  • Annual Notice of Changes, H0351 - 052 - Spanish (PDF)
Wellcare No Premium (HMO) H0351 - 053
  • Cochise, Mohave, Santa Cruz, Yuma
  • Annual Notice of Changes, H0351 - 053 - English (PDF)
  • Annual Notice of Changes, H0351 - 053 - Spanish (PDF)
Wellcare Giveback (HMO) H0351 - 054
  • Cochise, Mohave, Santa Cruz, Yuma
  • Annual Notice of Changes, H0351 - 054 - English (PDF)
  • Annual Notice of Changes, H0351 - 054 - Spanish (PDF)
Wellcare Assist (HMO) H0351 - 055
  • Maricopa, Pima, Pinal, Yavapai
  • Annual Notice of Changes, H0351 - 055 - English (PDF)
  • Annual Notice of Changes, H0351 - 055 - Spanish (PDF)
Wellcare Giveback (HMO) H0351 - 056
  • Maricopa, Pima, Pinal, Yavapai
  • Annual Notice of Changes, H0351 - 056 - English (PDF)
  • Annual Notice of Changes, H0351 - 056 - Spanish (PDF)
Wellcare No Premium Essentials (HMO) H5590-0005
  • Maricopa and Pinal
  • Annual Notice of Changes, H5590 - 005 - English (PDF)

  • Annual Notice of Changes, H5590 - 005 - Spanish (PDF)
Wellcare Assist (HMO) H5590 - 007
  • Cochise, Mohave, Santa Cruz, Yuma
  • Annual Notice of Changes, H5590 - 007 - English (PDF)

  • Annual Notice of Changes, H5590 - 007 - Spanish (PDF)


For HMO D-SNP Members

Plans  CMS# County Annual Notice of Change
Wellcare Dual Liberty (HMO D-SNP) H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yuma
  • Annual Notice of Changes, H5590 - 008 - English (PDF)

  • Annual Notice of Changes, H5590 - 008 - Spanish (PDF)
Wellcare Dual Liberty (HMO D-SNP) H5590 - 009
  • Apache, Coconino, Mohave, Navajo, Yavapai
  • Annual Notice of Changes, H5590 - 009 - English (PDF)

  • Annual Notice of Changes, H5590 - 009 - Spanish (PDF)
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 038
  • Maricopa, Pima and Pinal
  • Annual Notice of Changes, H0351 - 038 - English (PDF)
     
  • Annual Notice of Changes, H0351 - 038 - Spanish (PDF)
Wellcare Specialty No Premium (HMO C-SNP) H0351 - 057
  • Cochise, Mohave, Santa Cruz, Yavapai, Yuma
  • Annual Notice of Changes, H0351 - 057 - English (PDF)
     
  • Annual Notice of Changes, H0351 - 057 - Spanish (PDF)


For PPO Members

Plans  CMS# County Annual Notice of Changes
Wellcare No Premium Open (PPO) H8553 - 001
  • Maricopa, Pima
  • Annual Notice of Changes, H8553 - 001 - English (PDF)

Wellcare Patriot Giveback Open (PPO) H8553 - 002
  • Maricopa, Pima
  • Annual Notice of Changes, H8553 - 002 - English (PDF)

Wellcare No Premium Rx Plus Open (PPO) H8553 - 003
  • Maricopa, Pima
  • Annual Notice of Changes, H8553 - 003 - English (PDF)



Take care of your whole self with myStrength, (By clicking on this link you will be leaving the Allwell from Arizona Complete Health website.) an Arizona Complete Health program devoted to helping you manage depression, anxiety and stress.

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