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.
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| 2010 Evidence of Coverage | |||||||||||
| Classic | Signature | ||||||||||
2010 Summary of Benefits | |||||||||||
| Regional - Covers all WellCare PDP Service Areas | |||||||||||
2010 Pharmacy Directory | |||||||||||
| National Pharmacy Directory | |||||||||||
2010 Formulary | |||||||||||
| Comprehensive Formulary | |||||||||||
| Updates | |||||||||||
Other Forms
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| 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