MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
Plan Benefit Materials and Forms | Wellcare Oklahoma

Plan Materials and Forms
Information about plan benefits, services, and drug costs can be found in your plan materials.
Look at your Wellcare member ID card for your plan number and type to view materials for your plan.
- View a sample of an Wellcare 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 Wellcare ID card or have questions about plan materials, give us a call. We’re here to help.
This booklet gives you a summary of costs and coverage in your plan.
Please select the document for your plan and county:
For HMO Members:
Plan Name | CMS # | County | Summary of Benefits |
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Wellcare Giveback (HMO) | H9900-001 | Adair, Canadian, Cleveland, Creek, Grady, Le Flore, Lincoln, Logan, Mayes, Muskogee, Oklahoma, Okmulgee, Osage, Pottawatomie, Sequoyah, Wagoner |
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Wellcare No Premium (HMO) | H9900-004 | Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner |
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Wellcare No Premium (HMO) | H9900-005 | Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie |
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Wellcare Assist (HMO) | H9900-006 | Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner |
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Wellcare Assist (HMO) | H9900-007 | Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie |
For HMO SNP Members:
Plan Name | CMS # | County | Summary of Benefits |
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Wellcare Dual Access (HMO D-SNP) | H9900-002 | Adair, Canadian, Cleveland, Creek, Grady, Le Flore, Lincoln, Logan, Mayes, Muskogee, Oklahoma, Okmulgee, Osage, Pottawatomie, Sequoyah, Wagoner |
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Wellcare Dual Liberty (HMO D-SNP) | H9900-003 | Adair, Canadian, Cleveland, Creek, Grady, Le Flore, Lincoln, Logan, Mayes, Muskogee, Oklahoma, Okmulgee, Osage, Pottawatomie, Sequoyah, Wagoner |
For PPO Members:
Plan Name | CMS # | County | Summary of Benefits |
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Wellcare No Premium Open (PPO) | H4537-001 | [COUNTIES_SNP_001] |
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Wellcare No Premium Open (PPO) | H4537-002 | [COUNTIES_SNP_002] |
This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.
Please select the document for your plan and county:
For HMO Members:
Plan Name | CMS # | County | Evidence of Coverage |
---|---|---|---|
Wellcare Giveback (HMO) | H9900-001 | Adair, Canadian, Cleveland, Creek, Grady, Le Flore, Lincoln, Logan, Mayes, Muskogee, Oklahoma, Okmulgee, Osage, Pottawatomie, Sequoyah, Wagoner |
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Wellcare No Premium (HMO) | H9900-004 | Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner |
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Wellcare No Premium (HMO) | H9900-005 | Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie |
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Wellcare Assist (HMO) | H9900-006 | Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner |
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Wellcare Assist (HMO) | H9900-007 | Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie |
For HMO SNP Members:
Plan Name | CMS # | County | Evidence of Coverage |
---|---|---|---|
Wellcare Dual Access (HMO D-SNP) | H9900-002 | Adair, Canadian, Cleveland, Creek, Grady, Le Flore, Lincoln, Logan, Mayes, Muskogee, Oklahoma, Okmulgee, Osage, Pottawatomie, Sequoyah, Wagoner |
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Wellcare Dual Liberty (HMO D-SNP) | H9900-003 | Adair, Canadian, Cleveland, Creek, Grady, Le Flore, Lincoln, Logan, Mayes, Muskogee, Oklahoma, Okmulgee, Osage, Pottawatomie, Sequoyah, Wagoner |
For PPO Members:
Plan Name | CMS # | County | Evidence of Coverage |
---|---|---|---|
Wellcare No Premium Open (PPO) | H4537-001 | Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner |
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Wellcare No Premium Open (PPO) | H4537-002 | Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie |
Dental Benefit Summary:
A complete list of services, limitations and exclusions for your dental plan coverage is available below.
For HMO Members:
Plan Name | County | Summary of Benefits |
Allwell Medicare (HMO) | [COUNTIES_HMO_001] |
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Allwell Medicare (HMO) | [COUNTIES_HMO_002] |
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Allwell Medicare Select (HMO) |
[COUNTIES_HMO_003] |
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Allwell Medicare (HMO) | Baxter, Boone and Marion |
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Allwell Medicare Premier (HMO) | Baxter, Boone and Marion |
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Allwell Medicare Premier (HMO) | Benton, Carroll, Clay, Cleburne, Crawford, Cross, Franklin, Fulton, Independence, Izard, Jackson, Johnson, Lawrence, Logan, Madison, Mississippi, Newton, Perry, Poinsett, Prairie, Randolph, Scott, Searcy, Sebastian, Sharp, Stone, Van Buren, Washington, White, Woodruff, Yell. |
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