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Member Materials


Thank you for being a loyal customer of WellCare Prescription Insurance, Inc. On this page, you will be able to quickly find the  member communications and forms you will need as a member.

 

Click here to view this information in Spanish.


  

Member Communications
2010 Evidence of Coverage 
ClassicSignature  

2010 Summary of Benefits

Regional  - Covers all WellCare PDP Service Areas 
  

2010 Pharmacy Directory

National Pharmacy Directory  
  

2010 Formulary

Comprehensive Formulary 
Updates
 

Other Forms
Member Reimbursement Form 
Electronic Funds Transfer Form
Appointment of Representation Form  
Medicare Part D Coverage Determination Request Form (Provider)
Request for Medicare Prescription Drug Coverage Determination Form (Member)
WellCare Injectable Infusion Form
Medicare Redetermination (Appeal) Request
WellCare Provider/Physician Appeal Form
 

Information for Members who receive "Extra Help"

2010 LIS Premium Summary Chart  
Click here for more information on how to submit your proof of eligibility for extra help. 
Click here to view valid evidence of low income eligibility (Best Available Evidence).
 

 

Last modified: 03/05/2010