Plan Benefit Materials | Allwell from PA Health and Wellness
2027 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.”
Wellcare
Wellcare Simple (HMO-POS) H2915-003
Counties: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Bradford, Bucks, Butler, Cameron, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Cumberland, Dauphin, Delaware, Elk, 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, Snyder, Somerset, Sullivan, Susquehanna, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
Dental Benefit Details
HMO D-SNP Plans
Wellcare PA Health & Wellness 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 Liberty Sync (HMO-POS D-SNP) H2915-002 to Wellcare PA Health & Wellness Dual Liberty Sync (HMO-POS D-SNP) H2915-002 - English (PDF)
- Annual Notice of Change: Wellcare Dual Liberty Sync (HMO-POS D-SNP) H2915-002 to Wellcare PA Health & Wellness Dual Liberty Sync (HMO-POS D-SNP) H2915-002 - Spanish (PDF)
Summary of Benefits
Evidence of Coverage
Dental Benefit Details
Your OTC Highlight
Wellcare PA Health & Wellness 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
Annual Notice of Change
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - English (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Arabic (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Bengali (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Chinese (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - French Creole (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Nepali (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Russian (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Spanish (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Swahili (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Tamil (PDF)
- Annual Notice of Change: Wellcare Dual Select (HMO-POS D-SNP) H2915-018 to Wellcare PA Health & Wellness Dual Select (HMO-POS D-SNP) H2915-018 - Vietnamese (PDF)
Summary of Benefits
- Summary of Benefits - English (PDF)
- Summary of Benefits - Arabic (PDF)
- Summary of Benefits - Bengali (PDF)
- Summary of Benefits - Chinese (PDF)
- Summary of Benefits - French Creole (PDF)
- Summary of Benefits - Nepali (PDF)
- Summary of Benefits - Russian (PDF)
- Summary of Benefits - Swahili (PDF)
- Summary of Benefits - Tamil (PDF)
- Summary of Benefits - Vietnamese (PDF)
Evidence of Coverage
- Evidence of Coverage - English (PDF)
- Evidence of Coverage - Arabic (PDF)
- Evidence of Coverage - Bengali (PDF)
- Evidence of Coverage - Chinese (PDF)
- Evidence of Coverage - French Creole (PDF)
- Evidence of Coverage - Nepali (PDF)
- Evidence of Coverage - Russian (PDF)
- Evidence of Coverage - Swahili (PDF)
- Evidence of Coverage - Tamil (PDF)
- Evidence of Coverage - Vietnamese (PDF)
Dental Benefit Details
- Dental Benefit Details - English (PDF)
- Dental Benefit Details - Arabic (PDF)
- Dental Benefit Details - Bengali (PDF)
- Dental Benefit Details - Chinese (PDF)
- Dental Benefit Details - French Creole (PDF)
- Dental Benefit Details - Nepali (PDF)
- Dental Benefit Details - Russian (PDF)
- Dental Benefit Details - Spanish (PDF)
- Dental Benefit Details - Swahili (PDF)
- Dental Benefit Details - Tamil (PDF)
- Dental Benefit Details - Vietnamese (PDF)
Your OTC Highlight
Additional Forms
- Medicare Step Therapy Part B (PDF) - Coming Soon
- 2027 Medicare Parts A & B Premiums and Deductibles (PDF) - Coming Soon
- Member Secure Portal Guide (PDF) - Coming Soon
If you have questions please, contact Member Services.