Plan Benefit Materials |

Plan Materials and Forms

 

Listed below are some documents that may be helpful at different times during your membership. 

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
Allwell Medicare (HMO) H1664-001

Barry, Christian, Dallas, Greene, Jasper, Laclede, Lawrence, McDonald, Newton, Polk, Stone, Taney, Webster and Wright

Allwell Medicare (HMO) H1664-002

Cass, Clay, Jackson, and Platte

Allwell Medicare (HMO) H1664-004 Crawford, Franklin, Jefferson, Lincoln, St. Charles, St. Louis, St. Louis City, Warren and Washington


For HMO D-SNP Members:

Plan Name  CMS# County Summary of Benefits
Allwell Dual Medicare (HMO D-SNP) H1664 - 005 Barry, Cass, Christian, Clay, Crawford, Dallas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster and Wright

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 
Allwell Medicare (HMO) H1664-001

Barry, Christian, Dallas, Greene, Jasper, Laclede, Lawrence, McDonald, Newton, Polk, Stone, Taney, Webster and Wright

Allwell Medicare (HMO) H1664-002

Cass, Clay, Jackson, and Platte

Allwell Medicare (HMO) H1664-004 Crawford, Franklin, Jefferson, Lincoln, St. Charles, St. Louis, St. Louis City, Warren and Washington


For HMO D-SNP Members:

Plan Name  CMS# County Evidence of Coverage
Allwell Dual Medicare (HMO D-SNP) H1664 - 005 Barry, Cass, Christian, Clay, Crawford, Dallas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster and Wright

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
Allwell Medicare (HMO) H1664-001 Barry, Christian, Dallas, Greene, Jasper, Laclede, Lawrence, McDonald, Newton, Polk, Stone, Taney, Webster and Wright
Allwell Medicare (HMO) H1664-002 Cass, Clay, Jackson, and Platte
Allwell Medicare (HMO) H1664-004 Crawford, Franklin, Jefferson, Lincoln, St. Charles, St. Louis, St. Louis City, Warren and Washington


For HMO D-SNP Members:

Plan Name  CMS# County Annual Notice Of Changes
Allwell Dual Medicare (HMO D-SNP) H1664 - 005 Barry, Cass, Christian, Clay, Crawford, Dallas, Franklin, Greene, Jackson, Jasper, Jefferson, Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, St. Louis, St. Louis City, Stone, Taney, Warren, Washington, Webster and Wright

Your current plan may have an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. This catalog includes a list of OTC items that you can order to be mailed to your home. Check the catalog for item limits.

Ordering is easy. Just follow the steps in your plan's catalog.