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Plan Materials and Forms

Listed below are some documents that may be helpful at different times during your membership.  

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 (HMO) H5590 - 007
  • Coochise, Maricopa, Pima, Pinal, Santa Cruz, Yuma
  • Summary of Benefits, H5590 - 007 - English (PDF)
Allwell Medicare Essentials (HMO) H5590 - 005
  • Maricopa and Pinal
Allwell Medicare
H5590 - 004
  • Yuma


For HMO SNP Members

Plans  CMS# County Summary of Benefits
Allwell Dual Medicare  (HMO SNP)  H5590 - 008
  • Cochise, Gila, Graham, Greenlee, La Paz,
    Pinal, Maricopa, Pima, Santa Cruz and Yuma
  • Summary of Benefits, H5590 - 008 - 002 - English (PDF)
Allwell CHF/Diabetes Medicare (HMO 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
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
Allwell Medicare Essentials (HMO)

H5590 - 005

  • Maricopa, Pinal  
Allwell Medicare Essentials (HMO) H5590 - 007
  • Cochise, Maricopa, Pima, Pinal, Santa Cruz and Yuma
  • Evidence of Coverage, H5590 - 007 - Español (PDF)

 

For HMO SNP Members

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

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

H9287 - 001

  • Pima
Allwell Medicare Essentials II (HMO) H0351 - 050
  • Maricopa
Allwell Medicare Essentials II (HMO)

H0351 - 050

  • Pinal


For HMO SNP Members

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

For HMO Members

Plans CMS# County Low Income Subsidy
Allwell Medicare
(HMO)
H0351 - 044-001
  • Pima
Allwell Medicare
(HMO)
H0351 - 044-002
  • Cochise
Allwell Medicare
(HMO)

H0351 - 044-003

  • Santa Cruz
Allwell Medicare Premier
(HMO) 

H9287 - 001

  • Pima
Allwell Medicare Premier
(HMO)
H0351 - 050
  • Maricopa, Pima
Allwell Medicare Premier
(HMO)
H0351 - 051
  • Maricopa, Pima

For HMO SNP Members

Plans  CMS# County Low Income Subsidy
Allwell Dual Medicare
(HMO SNP) 
H5590 - 004
  • Maricopa
Allwell Dual Medicare
(HMO SNP) 

H5590 - 005
  • Maricopa, Pinal
Allwell Dual Medicare
(HMO SNP) 

H5590 - 006 - 001
  • Maricopa, Pima,
    Yuma
Allwell Dual Medicare
(HMO SNP)
H5590 - 006 - 002
  • Cochise, Gila,
    Graham, Greenlee,
    La Paz, Pinal,
    Santa Cruz
Allwell CHF/Diabetes
(HMO SNP)
H0351 - 038
  • Maricopa, Pinal

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.

 

medicare phone number

 

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