Plan Benefit Materials | Allwell from PA Health and Wellness

2026 Plan Benefit Materials

Explore your plan and its benefits by reviewing important documents like 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   |   HMO D-SNP

HMO Plans

Wellcare Assist (HMO-POS) H2915-011

Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Delaware, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, Mckean, Mercer, Mifflin, Monroe, Montgomery, Montour, Northampton, Perry, Philadelphia, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York

Annual Notice of Change

Summary of Benefits

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Patriot Giveback (HMO-POS) H2915-013

Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Delaware, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, Mckean, Mercer, Mifflin, Monroe, Montgomery, Montour, Northampton, Perry, Philadelphia, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York

Annual Notice of Change

Summary of Benefits

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Simple (HMO-POS) H2915-003

Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Delaware, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, Mckean, Mercer, Mifflin, Monroe, Montgomery, Montour, Northampton, Perry, Philadelphia, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York

Annual Notice of Change

Summary of Benefits

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

HMO D-SNP Plans

Wellcare Dual Liberty Sync (HMO-POS D-SNP) H2915-002

Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Delaware, Elk, Erie, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, Mckean, Mercer, Mifflin, Monroe, Montgomery, Montour, Northampton, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York


Wellcare Dual Select (HMO-POS D-SNP) H2915-018

Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Bucks, Butler, Cambria, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Delaware, Elk, Erie, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, Mckean, Mercer, Mifflin, Monroe, Montgomery, Montour, Northampton, Perry, Philadelphia, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon
  • Summary of Benefits - Arabic (PDF) - Coming Soon
  • Summary of Benefits - Bengali (PDF) - Coming Soon
  • Summary of Benefits - Chinese (PDF) - Coming Soon
  • Summary of Benefits - Creole/Haitian (PDF) - Coming Soon
  • Summary of Benefits - Nepali (PDF) - Coming Soon
  • Summary of Benefits - Russian (PDF) - Coming Soon
  • Summary of Benefits - Spanish (PDF) - Coming Soon
  • Summary of Benefits - Swahili (PDF) - Coming Soon
  • Summary of Benefits - Tamil (PDF) - Coming Soon
  • Summary of Benefits - Vietnamese (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon
  • Evidence of Coverage - Arabic (PDF) - Coming Soon
  • Evidence of Coverage - Bengali (PDF) - Coming Soon
  • Evidence of Coverage - Chinese (PDF) - Coming Soon
  • Evidence of Coverage - Creole/Haitian (PDF) - Coming Soon
  • Evidence of Coverage - Nepali (PDF) - Coming Soon
  • Evidence of Coverage - Russian (PDF) - Coming Soon
  • Evidence of Coverage - Spanish (PDF) - Coming Soon
  • Evidence of Coverage - Swahili (PDF) - Coming Soon
  • Evidence of Coverage - Tamil (PDF) - Coming Soon
  • Evidence of Coverage - Vietnamese (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon
  • Dental Benefit Details - Arabic (PDF) - Coming Soon
  • Dental Benefit Details - Bengali (PDF) - Coming Soon
  • Dental Benefit Details - Chinese (PDF) - Coming Soon
  • Dental Benefit Details - Creole/Haitian (PDF) - Coming Soon
  • Dental Benefit Details - Nepali (PDF) - Coming Soon
  • Dental Benefit Details - Russian (PDF) - Coming Soon
  • Dental Benefit Details - Spanish (PDF) - Coming Soon
  • Dental Benefit Details - Swahili (PDF) - Coming Soon
  • Dental Benefit Details - Tamil (PDF) - Coming Soon
  • Dental Benefit Details - Vietnamese (PDF) - Coming Soon

Additional Forms

  • Over-the-Counter Catalog (PDF) - Coming Soon
  • Over-the-Counter Catalog and Healthy Food (PDF) - Coming Soon

  • Medicare Step Therapy Part B (PDF) - Coming Soon

  • 2026 Medicare Parts A & B Premiums and Deductibles (PDF) - Coming Soon

  • Member Secure Portal Guide (PDF) - Coming Soon