Plan Benefit Materials | Allwell from Western Sky Community Care

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 D-SNP Members:

Plan Name  CMS # County Summary of Benefits
Allwell Dual Medicare (HMO D-SNP) H2134 - 001 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, and Valencia counties

 

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 D-SNP Members:

Plan Name  CMS # County Evidence of Coverage
Allwell Dual Medicare (HMO D-SNP) H2134 - 001 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, and Valencia counties

If you were enrolled in Allwell from Western Sky Community Care 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 D-SNP Members:

Plan Name  CMS # County Annual Notice of Changes
Allwell Dual Medicare (HMO D-SNP) H2134 - 001 Bernalillo, Chaves, Cibola, Curry, Dona Ana, Luna, McKinley, Quay, Roosevelt, San Juan, Sandoval, Santa Fe, Taos, Torrance, and Valencia counties

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.

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