Plan Benefit Materials and Forms | Wellcare Oklahoma

2026 Plan Benefit Materials

Explore your plan and its benefits by reviewing important documents like 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.”

PPO   |  PPO D-SNP

PPO Plans

Wellcare Patriot Giveback Open (PPO) H4537-005

Counties: Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, Mcclain, Mcintosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner

Annual Notice of Change

Summary of Benefits

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Simple Open (PPO) H4537-001

Counties: Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, Mcclain, Mcintosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner

Annual Notice of Change

Summary of Benefits

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

PPO D-SNP Plans

Wellcare Dual Access Open (PPO D-SNP) H4537-004

Counties: Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, Mcclain, Mcintosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner

Annual Notice of Change

Summary of Benefits

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Additional Forms

  • Over-the-Counter Catalog (PDF) - Coming Soon
  • Over-the-Counter Catalog and Healthy Food (PDF) - Coming Soon

  • Medicare Step Therapy Part B (PDF) - Coming Soon

  • 2026 Medicare Parts A & B Premiums and Deductibles (PDF) - Coming Soon

  • Member Secure Portal Guide (PDF) - Coming Soon