Plan Benefit Materials | Allwell from PA Health and Wellness
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.”
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
- Annual Notice of Change: Wellcare Simple (HMO) H2915-003 to Wellcare Simple (HMO-POS) H2915-003 - English (PDF)
- Annual Notice of Change: Wellcare Simple (HMO) H2915-016 to Wellcare Simple (HMO-POS) H2915-003 - English (PDF)
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
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
Annual Notice of Change
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H2915-002 to Wellcare Dual Liberty Sync (HMO-POS D-SNP) H2915-002 - English (PDF)
- Annual Notice of Change: Wellcare Dual Access (HMO D-SNP) H2915-007 to Wellcare Dual Liberty Sync (HMO-POS D-SNP) H2915-002 - English (PDF)
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
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