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


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  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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