Medicare Reference Documents

Listed below are some documents that may be helpful at different times during your membership.  

Can't find what you need?  Call Member Services.  We are here to help!

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 County Summary of Benefits
Allwell Medicare (HMO)

Duval, Lake, Pinellas, Polk, and Volusia counties

Allwell Medicare Premier (HMO)

Duval, Hernando, Pasco, Pinellas, Polk, and Volusia counties

Allwell Medicare (HMO)

Manatee, Marion, Palm Beach, and Seminole counties

Allwell Medicare (HMO)

Miami-Dade county

Allwell Medicare Premier (HMO) Miami-Dade county
Allwell Medicare (HMO) Hillsborough county
Allwell Medicare Premier (HMO) Hillsborough county
Allwell Medicare (HMO) Osceola county
Allwell Medicare Premier (HMO) Osceola county
Allwell Medicare (HMO) Orange county
Allwell Medicare Premier (HMO) Orange county
Allwell Medicare (HMO) Broward county
Allwell Medicare Premier (HMO) Broward county

For HMO SNP Members:  

Plan Name County  Summary of Benefits
Allwell Dual Medicare (HMO SNP)

Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk, and Volusia counties

Allwell Dual Medicare (HMO SNP)

Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Seminole, St. Lucie counties

Allwell Dual Medicare (HMO SNP)

Broward and Palm Beach counties

Allwell Dual Medicare (HMO SNP)

Miami - Dade county


Hillsborough county
Hillsborough county
Hillsborough county

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 County Evidence of Coverage 
Allwell Medicare (HMO)

Duval, Lake, Pinellas, Polk, and Volusia counties

Allwell Medicare Premier (HMO)

Duval, Hernando, Pasco, Pinellas, Polk, and Volusia counties

Allwell Medicare (HMO)

Manatee, Marion, Palm Beach, and Seminole counties

Allwell Medicare (HMO)

Miami-Dade county

Allwell Medicare Premier (HMO) Miami-Dade county
Allwell Medicare (HMO) Hillsborough county
Allwell Medicare Premier (HMO) Hillsborough county
Allwell Medicare (HMO) Osceola county
Allwell Medicare Premier (HMO) Osceola county
Allwell Medicare (HMO) Orange county
Allwell Medicare Premier (HMO) Orange county
Allwell Medicare (HMO) Broward county
Allwell Medicare Premier (HMO) Broward county

For HMO SNP Members:  

Plan Name County  Evidence of Coverage
Allwell Dual Medicare (HMO SNP)

Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk, and Volusia counties

Allwell Dual Medicare (HMO SNP)

Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Seminole, St. Lucie counties

Allwell Dual Medicare (HMO SNP)

Broward and Palm Beach counties

Allwell Dual Medicare (HMO SNP)

Miami - Dade county


HMO Reconsideration Form 

HMO SNP Redetermination Form 

HMO SNP Redetermination Form 

HMO Reconsideration Form 

This is the complete list of prescription drugs covered by Allwell.

Please select the document for your plan:

Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk, and Volusia counties

Hillsborough county
Hillsborough county
Hillsborough county
Hillsborough county

If you were enrolled in Sunshine Health Medicare Advantage 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  County ANOC
Allwell Medicare (HMO) Duval, Lake, Pinellas, Polk, and Volusia counties
Allwell Medicare Premier (HMO) Duval, Hernando, Pasco, Pinellas, Polk, and Volusia counties
Allwell Medicare (HMO) Manatee, Marion, Palm Beach, and Seminole counties
Allwell Medicare (HMO) Miami-Dade county
Allwell Medicare Premier (HMO) Miami-Dade county
  • Not Available
Allwell Medicare (HMO) Hillsborough county
  • Not Available
Allwell Medicare Premier (HMO) Hillsborough county
  • Not Available
Allwell Medicare (HMO) Osceola county
  • Not Available
Allwell Medicare Premier (HMO) Osceola county
  • Not Available
Allwell Medicare (HMO) Orange county
  • Not Available
Allwell Medicare Premier (HMO) Orange county
  • Not Available
Allwell Medicare (HMO) Broward county
  • Not Available
Allwell Medicare Premier (HMO) Broward county
  • Not Available

For HMO SNP Members:  

Plan Name County  ANOC
Allwell Dual Medicare (HMO SNP)

Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk, and Volusia counties

Allwell Dual Medicare (HMO SNP)

Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Seminole, St. Lucie counties

Allwell Dual Medicare (HMO SNP)

Broward and Palm Beach counties

Allwell Dual Medicare (HMO SNP)

Miami - Dade county

Your current plan may have an over-the-counter benefit that allows you to purchase over-the-counter (OTC) health and wellness products. This form includes a list of over-the-counter items that you can order to be directly mailed to your home.

Ordering is easy! Just follow the steps listed on your plan's form.

Please select the document for your plan and county:

For HMO Members:

Plan Name County OTC Benefits Brochure
Allwell Medicare (HMO) Miami-Dade county
Allwell Medicare Premier (HMO) Miami-Dade county
Allwell Medicare Premier (HMO) Orange county
Allwell Medicare (HMO) Broward county
Allwell Medicare Premier (HMO) Broward county

For HMO SNP Members:  

Plan Name County  OTC Benefits Brochure
Allwell Dual Medicare (HMO SNP)

Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk, and Volusia counties

Allwell Dual Medicare (HMO SNP)

Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Seminole, St. Lucie counties

Allwell Dual Medicare (HMO SNP)

Broward and Palm Beach counties

Allwell Dual Medicare (HMO SNP)

Miami - Dade county


OTC Benefits Brochure
OTC Benefits Brochure

Use one of the forms below to enroll and receive prescription drugs by mail.

Please select the form for the mail order pharmacy you would like to start using. 

Print and fill out the prescription claim form for your plan.

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. 

  • 2018- PHI Revocation Form
    • Use this form when you want Allwell to cancel or revoke your previous permission to share health information with a person or group.
  • 2018 - Appointing a Representative...Coming Soon
    • Use this form to name a person to act as your representative. Must be completed by you and accepted by the person you appoint.
  • Disenrollment Form
    • We don't want you to see you go. Let us improve your experience with our plan. Please call Member Services. We are here to help. If you are still dissatisfied, please fill out and mail the disenrollment form.
  • 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.

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!

Beginner's Guide to Medicare Booklet