Plan Benefit Materials and Forms | Wellcare Oklahoma
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.”
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
Your OTC Highlight
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
Your OTC Highlight
Additional Forms
- 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