Plan Benefit Materials | Allwell from Superior HealthPlan

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) | H0062-001 | Aransas, Bexar, Comal, El Paso, Guadalupe, Jim Wells, Nueces and Wilson counties |
|
Allwell Medicare (HMO) | H0062-002 | Collin, Dallas, Denton, Rockwall and Tarrant counties |
|
Allwell Medicare (HMO) | H0062-003 | Cameron, Hidalgo and Starr counties |
|
Allwell Medicare (HMO) |
H0062 - 009 | Fort Bend and Montgomery counties |
For HMO D-SNP Members:
Plan Name | CMS # | County | Summary of Benefits |
---|---|---|---|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-002 | Cameron, Hidalgo and Starr counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-003 | Collin, Dallas, Denton, Rockwall and Tarrant counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-004 | Aransas, Bexar, Comal, El Paso, Guadalupe, Jim Wells, Nueces and Wilson counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-007 |
Fort Bend and Montgomery counties | |
Allwell Dual Medicare (HMO D-SNP) |
H5294-009 |
Lubbock |
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) | H0062-001 |
|
|
Allwell Medicare (HMO) | H0062-002 | Collin, Dallas, Denton, Rockwall and Tarrant counties |
|
Allwell Medicare (HMO) | H0062-003 | Cameron, Hidalgo and Starr counties |
|
Allwell Medicare (HMO) | H0062-009 |
Fort Bend and Montgomery counties |
For HMO D-SNP Members:
Plan Name | CMS # | County | Evidence of Coverage |
---|---|---|---|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-002 | Cameron, Hidalgo and Starr counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-003 | Collin, Dallas, Denton, Rockwall and Tarrant counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-004 | Aransas, Bexar, Comal, El Paso, Guadalupe, Jim Wells, Nueces and Wilson counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-007 |
Fort Bend and Montgomery counties | |
Allwell Dual Medicare (HMO D-SNP) |
H5294-009 | Lubbock |
If you were enrolled in Superior HealthPlan 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 | CMS # | County | Annual Notice of Changes |
---|---|---|---|
Allwell Medicare (HMO) | H0062-001 | Aransas, Bexar, Comal, El Paso, Guadalupe, Jim Wells, Nueces and Wilson counties |
|
Allwell Medicare (HMO) | H0062-002 | Collin, Dallas, Denton, Rockwall and Tarrant counties |
|
Allwell Medicare (HMO) | H0062-003 | Cameron, Hidalgo and Starr counties |
|
Allwell Medicare (HMO) | H0062 - 009 | Fort Bend and Montgomery counties |
For HMO D-SNP Members:
Plan Name | CMS # | County | Annual Notice of Changes |
---|---|---|---|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-002 | Cameron, Hidalgo and Starr counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-003 | Collin, Dallas, Denton, Rockwall and Tarrant counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-002-004 | Aransas, Bexar, Comal, El Paso, Guadalupe, Jim Wells, Nueces and Wilson counties |
|
Allwell Dual Medicare (HMO D-SNP) |
H5294-007 |
Fort Bend and Montgomery 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.
Don’t want to wait? You may be able to pick up your OTC products from a CVS 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
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