Plan Benefit Materials | Allwell from Sunshine Health

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 Premier (HMO) | H9276 - 002 | Duval |
|
Allwell Medicare (HMO) |
H9276 - 004 | Miami-Dade | |
Allwell Medicare (HMO) |
H9276 - 0012 | Broward | |
Allwell Medicare (HMO) |
H9276 - 021 |
Palm Beach |
For HMO D-SNP Members:
Plan Name | CMS# | County | Summary of Benefits |
---|---|---|---|
Allwell Dual Medicare (HMO D-SNP) | H5190 - 001 | Duval | Volusia
|
|
Allwell Dual Medicare (HMO D-SNP) | H5190 - 002 | Hillsborough | Orange | Osceola | Palm Beach | Pasco | Pinellas | Polk | Seminole | |
Allwell Dual Medicare (HMO D-SNP) | H5190 - 003 | Broward | |
Allwell Dual Medicare (HMO D-SNP) | H5190 - 004 |
Miami - Dade |
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 Premier (HMO) | H9276 - 002 | Duval |
|
Allwell Medicare (HMO) |
H9276 - 004 | Miami-Dade | |
Allwell Medicare (HMO) |
H9276 - 012 | Broward | |
Allwell Medicare (HMO) |
H9276 - 021 |
Palm Beach |
For HMO D-SNP Members:
Plan Name | CMS# | County | Evidence of Coverage |
---|---|---|---|
Allwell Dual Medicare (HMO D-SNP) | H5190 - 001 | Duval | Volusia
|
|
Allwell Dual Medicare (HMO D-SNP) | H5190 - 002 | Hillsborough | Orange | Osceola | Palm Beach | Pasco | Pinellas | Polk | Seminole | |
Allwell Dual Medicare (HMO D-SNP) | H5190 - 003 | Broward | |
Allwell Dual Medicare (HMO D-SNP) | H5190 - 004 |
Miami - Dade |
If you were enrolled in Allwell from Sunshine Health 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) | H9276-002 | Duval | |
Allwell Medicare (HMO) |
H9276 - 004 | Miami-Dade | |
Allwell Medicare (HMO) |
H9276 - 021 | Palm Beach | |
Allwell Medicare (HMO) |
H9276 - 0012 | Broward |
For HMO D-SNP Members:
Plan Name | CMS# | County | Annual Notice Of Changes |
---|---|---|---|
Allwell Dual Medicare (HMO D-SNP) | H5190 - 001 | Baker | Duval | Hardee | Hernando | Lake | Manatee |Marion | Martin | Volusia
|
|
Allwell Dual Medicare (HMO D-SNP) | H5190 - 002 | Hillsborough | Orange | Osceola | Palm Beach | Pasco | Pinellas | Polk | Seminole | St.Lucie | |
Allwell Dual Medicare (HMO D-SNP) | H5190 - 003 | Broward | |
Allwell Dual Medicare (HMO D-SNP) | H5190 - 004 |
Miami - Dade |
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.
Don’t want to wait? You may pick up your OTC products from a CVS or Navarro Discount Pharmacy store near you. Please note: this does not include CVS locations inside of Target stores.
Connect to the CVS OTC website to view available products and store information.
Material ID: Y0020_20_17590WEB_C_03192020