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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 (HMO) H0062-001

Bexar, Guadalupe and Wilson county

Allwell Medicare (HMO) H0062-002

Collin, Dallas, Denton, Rockwall, Smith and Tarrant counties

Allwell Medicare (HMO) H0062-003

Cameron and Hidalgo counties

Allwell Medicare (HMO) H0062-004

El Paso county

Allwell Medicare (HMO) H0062-005 Nueces county
Allwell Medicare (HMO)
H0062 - 009 Fort Bend county
Allwell Medicare (HMO)
H0062 - 010 Williamson county

For HMO SNP Members:  

Plan Name CMS# County  Summary of Benefits
Allwell Dual Medicare (HMO SNP) H5294-002-001

Collin and Rockwall counties

Allwell Dual Medicare (HMO SNP) H5294-002-002

Cameron and Hidalgo counties

Allwell Dual Medicare (HMO SNP) H5294-002-003

Dallas, Smith and Tarrant counties

Allwell Dual Medicare (HMO SNP) H5294-002-004

Bexar, Guadalupe, Nueces and Wilson counties

Allwell Dual Medicare (HMO SNP)
H5294-006 El Paso county
Allwell Dual Medicare (HMO SNP)
H5294-007
Fort Bend county
Allwell Dual Medicare (HMO SNP)
H5294-008
Williamson 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 CMS# County Evidence of Coverage 
Allwell Medicare (HMO) H0062-001

Bexar, Guadalupe and Wilson county

Allwell Medicare (HMO) H0062-002

Collin, Dallas, Denton, Rockwall, Smith and Tarrant counties

Allwell Medicare (HMO) H0062-003

Cameron and Hidalgo counties

Allwell Medicare (HMO) H0062-004

El Paso county

Allwell Medicare (HMO) H0062-005 Nueces county
Allwell Medicare (HMO) H0062-009
Fort Bend county

Allwell Medicare (HMO) H0062-010
Williamson county

 

For HMO SNP Members:

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

H5294-002-001

Collin and Rockwall counties

Allwell Dual Medicare
(HMO SNP)

H5294-002-002

Cameron and Hidalgo counties

Allwell Dual Medicare
(HMO SNP)

H5294-002-003

Dallas, Smith and Tarrant counties

Allwell Dual Medicare
(HMO SNP)

H5294-002-004

Bexar, Guadalupe, Nueces and Wilson counties

Allwell Dual Medicare
(HMO SNP)
H5294-006

El Paso county
Allwell Dual Medicare
(HMO SNP)

H5294-007

Fort Bend county
Allwell Dual Medicare
(HMO SNP)

H5294-008 Williamson county

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 Bexar, Guadalupe and Wilson county
Allwell Medicare (HMO) H0062-002 Collin, Dallas, Denton, Rockwall, Smith and Tarrant counties 
Allwell Medicare (HMO) H0062-003 Cameron and Hidalgo counties
Allwell Medicare (HMO) H0062-004 El Paso county
Allwell Medicare (HMO) H0062-005 Nueces county

For HMO SNP Members:  

Plan Name CMS# County  Annual Notice Of Changes
Allwell Dual Medicare 
(HMO SNP)
H5294-002-001

Collin and Rockwall counties

Allwell Dual Medicare 
(HMO SNP)
H5294-002-002

Cameron and Hidalgo counties

Allwell Dual Medicare 
(HMO SNP)
H5294-002-003

Dallas, Smith and Tarrant counties

Allwell Dual Medicare 
(HMO SNP)
H5294-002-004

Bexar, Guadalupe, Nueces and Wilson counties

ñIf 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 Low Income Subsidy
Allwell Medicare (HMO)

H0062-001 Bexar, Guadalupe and Wilson county
Allwell Medicare (HMO)

H0062-002 Collin, Dallas, Denton, Rockwall, Smith and Tarrant counties 
Allwell Medicare (HMO)

H0062-003 Cameron and Hidalgo counties
Allwell Medicare (HMO)

H0062-004 El Paso county
Allwell Medicare (HMO)

H0062-005 Nueces county
Allwell Medicare (HMO) H0062-009
Fort Bend county
Allwell Medicare (HMO)

H0062-0010
Williamson county

For HMO SNP Members:  

Plan Name CMS# County  Low Income Subsidy
Allwell Dual Medicare 
(HMO SNP)
H5294-002-001

Collin and Rockwall counties

Allwell Dual Medicare 
(HMO SNP)
H5294-002-002

Cameron and Hidalgo counties

Allwell Dual Medicare 
(HMO SNP)
H5294-002-003

Dallas, Smith and Tarrant counties

Allwell Dual Medicare 
(HMO SNP)
H5294-002-004

Bexar, Guadalupe, Nueces and Wilson counties

Allwell Dual Medicare (HMO SNP) H5294-006 El Paso county
Allwell Dual Medicare (HMO SNP)
H5294-007 Fort Bend county
Allwell Dual Medicare (HMO SNP)
H5294-008 Williamson 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 catalog includes a list of over-the-counter items that you can order to be directly mailed to your home. Check the catalog for item limits.

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

  • Beginners Guide to Medicare Booklet (PDF)
    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!

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. 

  • 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

 

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