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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) H3499-001

Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Madison, Marion, Posey, Shelby, Tippecanoe, Tipton, Vanderburgh, and Warrick counties

Allwell Medicare (HMO) H3499-002

Allen, Elkhart, LaPorte, Lake, Porter, St. Joseph, Wells and Whitley counties

For HMO SNP Members:

Plan Name CMS# County Summary of Benefits
Allwell Dual Medicare (HMO SNP) H3499 -  005 

Allen, Boone, Delaware, Elkhart, Hamilton, Hancock, Hendricks, Howard, Johnson, Lake, LaPorte, Madison, Marion, Porter, Posey, Shelby, St. Joseph, Tippecanoe, Tipton, Vanderburgh, Warrick, Wells and Whitley counties

For PPO Members:

Plan Name CMS# County Summary of Benefits
Allwell Medicare (PPO) H6348-001

Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Madison, Marion, Shelby, Tippecanoe and Tipton counties

Allwell Medicare (PPO) H6348-002

Allen, Elkhart, St. Joseph, Wells and Whitley counties

Allwell Medicare (PPO) H6348-003

Posey, Vanderburgh and Warrick counties

Allwell Medicare (PPO) H6348-004 LaPorte, Lake and Porter 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) H3499-001

Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Madison, Marion, Posey, Shelby, Tippecanoe, Tipton, Vanderburgh, and Warrick counties

Allwell Medicare (HMO) H3499-002

Allen, Elkhart, LaPorte, Lake, Porter, St. Joseph, Wells and Whitley counties

For HMO SNP Members:

Plan Name CMS# County Evidence of Coverage
Allwell Dual Medicare (HMO SNP) H3499 005 

Allen, Boone, Delaware, Elkhart, Hamilton, Hancock, Hendricks, Howard, Johnson, Lake, LaPorte, Madison, Marion, Porter, Posey, Shelby, St. Joseph, Tippecanoe, Tipton, Vanderburgh, Warrick, Wells and Whitley counties

For PPO Members:

Plan Name CMS# County Evidence of Coverage
Allwell Medicare (PPO) H6348-001

Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Madison, Marion, Shelby, Tippecanoe and Tipton counties

Allwell Medicare (PPO) H6348-002

Allen, Elkhart, St. Joseph, Wells and Whitley counties

Allwell Medicare (PPO) H6348-003

Posey, Vanderburgh and Warrick counties

Allwell Medicare (PPO) H6348-004 LaPorte, Lake and Porter counties

If you were enrolled in Allwell from Managed Health Services (MHS) last year, 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) H3499-001

Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Madison, Marion, Shelby, Tippecanoe and Tipton counties

Allwell Medicare (HMO) H3499-002 Allen, Elkhart, St. Joseph, Wells and Whitley counties
Allwell Medicare (HMO) H3499-003 Posey, Vanderburgh and Warrick counties


For PPO Members:

Plan Name CMS# County  Annual Notice Of Changes
Allwell Medicare (PPO) H6348-001

Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Madison, Marion, Shelby, Tippecanoe and Tipton counties

Allwell Medicare (PPO) H6348-002

Allen, Elkhart, St. Joseph, Wells and Whitley counties

Allwell Medicare (PPO) H6348-003 Posey, Vanderburgh and Warrick counties

 

If you were enrolled in Allwell from Managed Health Services (MHS) last year, 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) H3499 - 001 Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Madison, Marion, Shelby, Tippecanoe and Tipton counties
Allwell Medicare (HMO)

H3499 - 002

Allen, Elkhart, St. Joseph, Wells and Whitley counties
Allwell Medicare (HMO)

H3499 - 003
Posey, Vanderburgh and Warrick counties
Allwell Medicare (HMO)
H3499 - 004

LaPorte, Lake and Porter counties

For HMO SNP Members:

Plan Name CMS# County Low Income Subsidy
Allwell Dual Medicare (HMO SNP) H3499 005 

Allen, Boone, Delaware, Elkhart, Hamilton, Hancock, Hendricks, Howard, Johnson, LaPorte, Lake, Madison, Marion, Porter, Posey, Shelby, St.Joseph, Tippecanoe, Tipton, Vanderburgh, Warrick, Wells and Whitley counties

For PPO Members:

Plan Name  CMS# County  Low Income Subsidy
Allwell Medicare (PPO) H6348 - 001 Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Madison, Marion, Shelby, Tippecanoe and Tipton counties
Allwell Medicare (PPO) H6348 - 002

Allen, Elkhart, St. Joseph, Wells and Whitley counties

Allwell Medicare (PPO) H6348 - 003

Posey, Vanderburgh and Warrick counties
Allwell Medicare (PPO)

H6348 - 004

LaPorte, Lake and Porter 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.

  • Beginner's Guide to Medicare Booklet (PDF)
    Important choices can be simple choices. So let us help! Take a look at the below 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!