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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 counties

Allwell Medicare (HMO) H1664-002

Cass, Clay, Jackson, and Platte counties

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


For HMO SNP Members:

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

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 counties

Allwell Medicare (HMO) H1664-002

Cass, Clay, Jackson, and Platte counties

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


For HMO SNP Members:

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

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, Lawrence, McDonald, Newton, Polk and Webster counties
Allwell Medicare (HMO) H1664-002 Cass, Clay, Jackson and Platte counties

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 Low Income Subsidy
Allwell Medicare (HMO)

H1664-001 Barry, Christian, Dallas, Greene, Jasper, Lawrence, McDonald, Newton, Polk and Webster counties
Allwell Medicare (HMO)

H1664-002 Cass, Clay, Jackson and Platte counties
Allwell Medicare (HMO) H1664-004 Crawford, Franklin, Jefferson, Lincoln, St. Charles, Warren and Washington counties


For HMO SNP Members:

Plan Name  CMS# County Low Income Subsidy
Allwell Dual  Medicare (HMO SNP)

H1664-005
Barry, Cass, Christian, Clay, Crawford, Dallas, Franklin, Greene, Jackson, Jasper, Jefferson, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, Warren, Washington and Webster counties
 

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.

  • Beginners Guide to Medicare (PDF)
    Important choices can be simple choices. So let us help! Take a look at the Beginner's Guide to Medicare booklet. Our Medicare guide will give you a solid foundation for understanding the basics of Medicare and available options you have as a new Medicare beneficiary. If you have any questions or need assistance, call us. We are here to help!

This is an introduction to the provider and pharmacy directory, including an explanation of the provider symbols found in the directory.

Visit our Find a Doctor or Pharmacy page to learn more. 

  • Best Available Evidence (BAE)
    • This is a CMS policy that allows for changes to cost-sharing for low-income beneficiaries when there is evidence that information from a beneficiary is not up-to-date or accurate.

medicare phone number

 

Can't find what you need? Contact Member Services. We are here to help!