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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) H2915-003 Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren, Washington and Westmoreland
Allwell Medicare (HMO)
H2915-006

Berks, Bradford, Bucks, Centre, Chester, Cumberland, Dauphin, Delaware, Fulton, Huntingdon, Juniata, Lackawanna, Lancaster, Lebanon, Lycoming, Mifflin, Montgomery, Perry, Philadelphia, Synder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming counties

For HMO SNP Members:  

Plan Name CMS# County  Summary of Benefits
Allwell Dual Medicare
(HMO SNP)
H2915-001

Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren, Washington and Westmoreland counties

Allwell Dual Medicare
(HMO SNP)

H2915-002

Bucks, Chester, Delaware, Montgomery, and Philadelphia counties

 

Allwell Dual Medicare
(HMO SNP)
H2915-007 Adam, Berks, Bradford, Carbon, Centre, Clinton, Cumberland, Dauphin, Franklin, Fulton Huntingdon, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzeme, Lycoming, Mifflin, Monroe, Northampton, Perry, Pike, Schuykill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming and York 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 Members:

Plan Name CMS# County Evidence of Coverage 
Allwell Medicare (HMO) H2915-003

Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren, Washington and Westmoreland

Allwell Medicare (HMO) H2915-006 Berks, Bradford, Bucks, Centre, Chester, Cumberland, Dauphin, Delaware, Fulton, Huntingdon, Juniata, Lackawanna, Lancaster, Lebanon, Lycoming, Mifflin, Montgomery, Perry, Philadelphia, Synder, Sullivan, Susquehanna, Tioga, Union, Wayne and Wyoming counties

For HMO SNP Members:  

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

H2915-001

Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren, Washington and Westmoreland counties

Allwell Dual Medicare
(HMO SNP)

H2915-002 Bucks, Chester, Delaware, Montgomery, and Philadelphia counties
Allwell Dual Medicare
(HMO SNP)
H2915-007 Adam, Berks, Bradford, Carbon, Centre, Clinton, Cumberland, Dauphin, Franklin, Fulton Huntingdon, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzeme, Lycoming, Mifflin, Monroe, Northampton, Perry, Pike, Schuykill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming and York counties

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)

H2915-003 Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland counties


For HMO SNP Members:  

Plan Name CMS# County  Annual Notice Of Changes
Allwell Dual Medicare (HMO SNP) H2915-001 Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland counties
Allwell Dual Medicare (HMO SNP) H2915-002

Bucks, Chester, Delaware, Montgomery and Philadelphia counties

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) H2915-003 Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland counties
Allwell Medicare (HMO)
H2915-005

Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Venango and Warren
Allwell Medicare (HMO)
H2915-006

Bucks, Chester, Delaware, Fulton, Huntingdon, Montgomery and Philadelphia counties

For HMO SNP Members:  

Plan Name CMS# County  Low Income Subsidy
Allwell Dual Medicare (HMO SNP) H2915-001

Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland counties

Allwell Dual Medicare (HMO SNP)

H2915-002

Bucks, Chester, Delaware, Montgomery and Philadelphia counties

 

Allwell Dual Medicare (HMO SNP)
H2915-007 Fulton and Huntingdon counties
Allwell Dual Medicare (HMO SNP)
H2915-009 Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango and Warren 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.

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!