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- Shop for Plans show Shop for Plans menu
- I'm a Member show I'm a Member menu
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Pharmacy Benefits
show Pharmacy Benefits menu
-
- Find a Doctor or Pharmacy
- List of Drugs (Formulary)
- Medication Therapy Management (MTMP)
- Mail Order Service
- Specialty Pharmacy
- Coverage Determinations and Redeterminations
- Prior Authorization, Step Therapy & Quantity Limitations
- Out-of-Network Pharmacies
- Medication (Drug) Management and Safety
- Drug Transition Policy
- Pharmacy Forms
- Medicare Prescription Payment Plan
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Plan Benefit Materials and Forms | Wellcare Oklahoma
Plan Benefit Materials
Learn about your plan and all that it has to offer by reviewing helpful plan documents such as 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.”
HMO
Additional Forms
Plan Benefit Materials
Learn about your plan and all that it has to offer by reviewing helpful plan documents such as 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.”
HMO
Wellcare Giveback (HMO-POS) H9900-001
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 Changes
Summary of Benefits
Evidence of Coverage
Wellcare Simple (HMO-POS) H9900-005
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 Changes
- Annual Notice of Change: Wellcare No Premium (HMO) to Wellcare Simple (HMO-POS) - English (PDF)
- Annual Notice of Change: Wellcare No Premium (HMO) to Wellcare Simple (HMO-POS) - English (PDF)
Summary of Benefits
Evidence of Coverage
Wellcare Assist (HMO-POS) H9900-006
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 Changes
- Annual Notice of Change: Wellcare Assist (HMO) H9900-006 to Wellcare Assist (HMO-POS) H9900-006 - English (PDF)
- Annual Notice of Change: Wellcare Assist (HMO) H9900-007 to Wellcare Assist (HMO-POS) H9900-006 - English (PDF)
Summary of Benefits
Evidence of Coverage
Wellcare Patriot Simple (HMO-POS) H9900-008
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 Changes
Summary of Benefits
Evidence of Coverage
HMO D-SNP
Wellcare Dual Liberty (HMO-POS D-SNP) H9900-003
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 Changes
- Annual Notice of Change: Wellcare All Dual Assure (HMO D-SNP) to Wellcare Dual Liberty (HMO-POS D-SNP) - English (PDF)
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) to Wellcare Dual Liberty (HMO-POS D-SNP) - English (PDF)
- Annual Notice of Change: Wellcare Dual Liberty (HMO D-SNP) to Wellcare Dual Liberty (HMO-POS D-SNP) - English (PDF)
Summary of Benefits
Evidence of Coverage
Wellcare Dual Reserve (HMO-POS D-SNP) H9900-009
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 Changes
Summary of Benefits
Evidence of Coverage
PPO
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 Changes
- Annual Notice of Change: Wellcare No Premium Open (PPO) to Wellcare Simple Open (PPO) - English (PDF)
- Annual Notice of Change: Wellcare No Premium Open (PPO) to Wellcare Simple Open (PPO) - English (PDF)
Summary of Benefits
Evidence of Coverage
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
Summary of Benefits
Evidence of Coverage
PPO D-SNP
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 Changes
Summary of Benefits
Evidence of Coverage
Additional Forms
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