Plan Benefit Materials and Forms

Plan Name	CMS #	County	Summary of Benefits
Wellcare Giveback (HMO)	H9900-001	Adair, Canadian, Cleveland, Creek, Grady, Le Flore, Lincoln, Logan, Mayes, Muskogee, Oklahoma, Okmulgee, Osage, Pottawatomie, Sequoyah, Wagoner	Summary of Benefits, H9900-001 - English (PDF)
Wellcare No Premium (HMO)	H9900-004	Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner	Summary of Benefits, H9900-004 - English (PDF)
Wellcare No Premium (HMO)	H9900-005	Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie	Summary of Benefits, H9900-005 - English (PDF)
Wellcare Assist (HMO)	H9900-006	Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner	Summary of Benefits, H9900-006 - English (PDF)
Wellcare Assist (HMO)	H9900-007	Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie	Summary of Benefits, H9900-007 - English (PDF)

Plan Name	CMS #	County	Summary of Benefits
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	Summary of Benefits, H9900-002 - English (PDF)
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	Summary of Benefits, H9900-003 - English (PDF)

Plan Name	CMS #	County	Summary of Benefits
Wellcare No Premium Open (PPO)	H4537-001	[COUNTIES_SNP_001]	Summary of Benefits, H4537-001 - English (PDF)
Wellcare No Premium Open (PPO)	H4537-002	[COUNTIES_SNP_002]	Summary of Benefits, H4537-002 - English (PDF)

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	Evidence of Coverage, H9900-001 - English (PDF)
Wellcare No Premium (HMO)	H9900-004	Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner	Evidence of Coverage, H9900-004 - English (PDF)
Wellcare No Premium (HMO)	H9900-005	Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie	Evidence of Coverage, H9900-005 - English (PDF)
Wellcare Assist (HMO)	H9900-006	Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner	Evidence of Coverage, H9900-006 - English (PDF)
Wellcare Assist (HMO)	H9900-007	Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie	Evidence of Coverage, H9900-007 - English (PDF)

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	Evidence of Coverage, H9900-002 - English (PDF)
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	Evidence of Coverage, H9900-003 - English (PDF)

Plan Name	CMS #	County	Evidence of Coverage
Wellcare No Premium Open (PPO)	H4537-001	Adair, Creek, Le Flore, Mayes, Muskogee, Okmulgee, Osage, Sequoyah, Wagoner	Evidence of Coverage, H4537-001 - English (PDF)
Wellcare No Premium Open (PPO)	H4537-002	Canadian, Cleveland, Grady, Lincoln, Logan, Oklahoma, Pottawatomie	Evidence of Coverage, H4537-002 - English (PDF)

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
Wellcare Giveback (HMO)	H9900-001	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H9900-001 - English (PDF)
Wellcare No Premium (HMO)	H9900-004	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H9900-004 - English (PDF)
Wellcare No Premium (HMO)	H9900-005	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Summary of Benefits, H9900-005 - English (PDF)
Wellcare Assist (HMO)	H9900-006	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H9900-006 - English (PDF)
Wellcare Assist (HMO)	H9900-007	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Summary of Benefits, H9900-007 - English (PDF)
Wellcare Patriot No Premium (HMO)	H9900-008	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H9900-008 - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare Dual Access (HMO D-SNP)	H9900-002	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H9900-002 - English (PDF)
Wellcare Dual Liberty (HMO D-SNP)	H9900-003	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H9900-003 - English (PDF)

For PPO Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare No Premium Open (PPO)	H4537-001	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H4537-001 - English (PDF)
Wellcare No Premium Open (PPO)	H4537-002	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Summary of Benefits, H4537-002 - English (PDF)
Wellcare Low Premium Open (PPO)	H4537-003	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H4537-003 - English (PDF)

For PPO D-SNP Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare Dual Access Open (PPO D-SNP)	H4537-004	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Summary of Benefits, H4537-001 - English (PDF)

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	Evidence of Coverage
Wellcare Giveback (HMO)	H9900-001	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H9900-001 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare No Premium (HMO)	H9900-004	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H9900-004 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare No Premium (HMO)	H9900-005	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Evidence of Coverage, H9900-005 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare Assist (HMO)	H9900-006	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H9900-006 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare Assist (HMO)	H9900-007	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Evidence of Coverage, H9900-007 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare Patriot No Premium (HMO)	H9900-008	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H9900-008 - English (PDF) Dental Benefit Details - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Evidence of Coverage
Wellcare Dual Access (HMO D-SNP)	H9900-002	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H9900-002 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare Dual Liberty (HMO D-SNP)	H9900-003	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H9900-003 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage

Wellcare Dual Access (HMO D-SNP)

H9900-002

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

Evidence of Coverage, H9900-002 - English (PDF)

Dental Benefit Details - English (PDF)

Wellcare Dual Liberty (HMO D-SNP)

H9900-003

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

Evidence of Coverage, H9900-003 - English (PDF)

Dental Benefit Details - English (PDF)

For PPO Members:

Plan Name	CMS #	County	Evidence of Coverage
Wellcare No Premium Open (PPO)	H4537-001	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H4537-001 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare No Premium Open (PPO)	H4537-002	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Evidence of Coverage, H4537-002 - English (PDF) Dental Benefit Details - English (PDF)
Wellcare Low Premium Open (PPO)	H4537-003	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H4537-003 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage

Wellcare No Premium Open (PPO)

H4537-001

Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner

Evidence of Coverage, H4537-001 - English (PDF)

Dental Benefit Details - English (PDF)

Wellcare No Premium Open (PPO)

H4537-002

Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole

Evidence of Coverage, H4537-002 - English (PDF)

Dental Benefit Details - English (PDF)

Wellcare Low Premium Open (PPO)

H4537-003

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

Evidence of Coverage, H4537-003 - English (PDF)

Dental Benefit Details - English (PDF)

For PPO D-SNP Members:

Plan Name	CMS #	County	Evidence of Coverage
Wellcare Dual Access Open (PPO D-SNP)	H4537-004	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Evidence of Coverage, H4537-004 - English (PDF) Dental Benefit Details - English (PDF)

Plan Name

CMS #

County

Evidence of Coverage

Wellcare Dual Access Open (PPO D-SNP)

H4537-004

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

Evidence of Coverage, H4537-004 - English (PDF)

Dental Benefit Details - English (PDF)

This booklet will tell you about changes to your plan's costs and benefits for the coming year.

Please select the document for your plan and county:

For HMO Members:

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare Giveback (HMO)	H9900-001	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Annual Notice of Changes, H9900-001 - English (PDF)
Wellcare No Premium (HMO)	H9900-004 to H9900-004	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Annual Notice of Changes, H9900-004 - English (PDF)
Wellcare No Premium (HMO)	H9900-005	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Annual Notice of Changes, H9900-005 - English (PDF)
Wellcare Assist (HMO)	H9900-006	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Annual Notice of Changes, H9900-006 - English (PDF)
Wellcare Assist (HMO)	H9900-007	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Annual Notice of Changes, H9900-007 - English (PDF)

For HMO D-SNP Members:

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare Dual Access (HMO D-SNP)	H9900-002	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Annual Notice of Changes, H9900-002 - English (PDF)
Wellcare Dual Liberty (HMO D-SNP)	H9900-003	Adair, Caddo, Canadian, Cherokee, Cleveland, Comanche, Creek, Delaware, Garfield, Garvin, Grady, Kay, Le Flore, Lincoln, Logan, Mayes, McClain, McIntosh, Muskogee, Oklahoma, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Pottawatomie, Rogers, Seminole, Sequoyah, Tulsa, Wagoner	Annual Notice of Changes, H9900-003 - English

For PPO Members:

Plan Name	CMS #	County	Annual Notice of Changes
Wellcare No Premium Open (PPO)	H4537-001	Adair, Cherokee, Creek, Delaware, Le Flore, Mayes, McIntosh, Muskogee, Okmulgee, Osage, Ottawa, Payne, Pittsburg, Rogers, Sequoyah, Tulsa, Wagoner	Annual Notice of Changes, H4537-001 - English (PDF)
Wellcare No Premium Open (PPO)	H4537-002	Caddo, Canadian, Cleveland, Comanche, Garfield, Garvin, Grady, Kay, Lincoln, Logan, McClain, Oklahoma, Pottawatomie, Seminole	Annual Notice of Changes, H4537-002 - English (PDF)

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]	Summary of Benefits 5000-1001 (PDF) Certificate of Benefits 5000- 1001 (PDF)
Allwell Medicare (HMO)	[COUNTIES_HMO_002]	Summary of Benefits 5000-0002 (PDF) Certificate of Benefits 5000-0002 (PDF)
Allwell Medicare Select (HMO)	[COUNTIES_HMO_003]	Summary of Benefits 5000-0003 (PDF) Certificate of Benefits 5000-0003 (PDF)
Allwell Medicare (HMO)	Baxter, Boone and Marion	Summary of Benefits 5000-0004 (PDF) Certificate of Benefits 5000-0004 (PDF)
Allwell Medicare Premier (HMO)	Baxter, Boone and Marion	Summary of Benefits 5000-0005 (PDF) Certificate of Benefits 5000-0005 (PDF)
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.	Summary of Benefits 5000-0006 (PDF) Certificate of Benefits 5000-0006 (PDF)

AHIP Flyer (PDF)

Plan Benefit Materials and Forms | Wellcare Oklahoma

Plan Materials and Forms

For HMO Members:

For HMO SNP Members:

For PPO Members:

For HMO Members:

For HMO SNP Members:

For PPO Members:

Dental Benefit Summary:

For HMO Members:

For HMO D-SNP Members:

For PPO Members:

For PPO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For PPO Members:

For PPO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

For PPO Members:

Dental Benefit Summary:

Plan Benefit Materials and Forms | Wellcare Oklahoma

Plan Materials and Forms

Summary of Benefits (SB)

For HMO Members:

For HMO SNP Members:

For PPO Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO SNP Members:

For PPO Members:

Dental

Dental Benefit Summary:

Over-The-Counter Benefits

Summary of Benefits (SB)

For HMO Members:

For HMO D-SNP Members:

For PPO Members:

For PPO D-SNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D-SNP Members:

For PPO Members:

For PPO D-SNP Members:

Annual Notice of Change (ANOC)

For HMO Members:

For HMO D-SNP Members:

For PPO Members:

Dental

Dental Benefit Summary:

Over-The-Counter Benefits

2023 AHIP Flyer