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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 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 SNP Members:

Plan Name   CMS#  County Summary of Benefits
Allwell Dual Medicare (HMO SNP) H5190 - 001

Duval | Volusia

 

Allwell Dual Medicare (HMO SNP) H5190 - 002 Hillsborough | Orange | Osceola | Palm Beach | Pasco | Pinellas | Polk | Seminole
Allwell Dual Medicare (HMO SNP) H5190 - 003 Broward
Allwell Dual Medicare (HMO 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 SNP Members:

Plan Name   CMS#  County Evidence of Coverage
Allwell Dual Medicare (HMO SNP) H5190 - 001

Duval | Volusia

 

Allwell Dual Medicare (HMO SNP) H5190 - 002 Hillsborough | Orange | Osceola | Palm Beach | Pasco | Pinellas | Polk | Seminole
Allwell Dual Medicare (HMO SNP) H5190 - 003 Broward
Allwell Dual Medicare (HMO SNP) H5190 - 004

Miami - Dade

 

ñIf 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 Premier (HMO) H9276 - 002

Duval

Allwell Medicare (HMO)
H9276 - 004 Miami-Dade
Allwell Medicare (HMO)
H9276 - 006 Hillsborough | Pasco | Pinellas
Allwell Medicare (HMO)
H9276 - 0010 Orange | Osceola | Seminole
Allwell Medicare (HMO)
H9276 - 0012 Broward

 

For HMO SNP Members:

Plan Name   CMS#  County Annual Notice Of Changes
Allwell Dual Medicare (HMO SNP) H5190 - 001

Baker | Duval | Hardee | Hernando | Lake | Manatee |Marion | Martin | Volusia

 

Allwell Dual Medicare (HMO SNP) H5190 - 002 Hillsborough | Orange | Osceola | Palm Beach | Pasco | Pinellas | Polk | Seminole | St.Lucie
Allwell Dual Medicare (HMO SNP) H5190 - 003 Broward
Allwell Dual Medicare (HMO 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 Low Income Subsidy
Allwell Medicare Premier (HMO) H9276 - 002

Duval

Allwell Medicare (HMO)
H9276 - 004 Miami-Dade
Allwell Medicare (HMO)
H9276 - 006 Hillsborough | Pasco | Pinellas
Allwell Medicare (HMO)
H9276 - 010 Orange | Osceola | Seminole
Allwell Medicare (HMO)
H9276 - 012 Broward
Allwell Medicare (HMO) H9276 - 021 Palm Beach
Allwell Medicare (HMO) H9276 - 022 Polk
Allwell Medicare (HMO) H9276 - 023 Volusia

 

For HMO SNP Members:

Plan Name   CMS#  County Low Income Subsidy
Allwell Dual Medicare (HMO SNP) H5190 - 001

Baker | Duval | Hardee | Hernando | Lake | Manatee |Marion | Martin | Volusia

 

Allwell Dual Medicare (HMO SNP) H5190 - 002 Hillsborough | Orange | Osceola | Palm Beach | Pasco | Pinellas | Polk | Seminole | St.Lucie
Allwell Dual Medicare (HMO SNP) H5190 - 003 Broward
Allwell Dual Medicare (HMO 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 can 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.

  • 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

 

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