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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 parish:

For HMO Members:

Plan Name CMS# Parish Summary of Benefits
Allwell Medicare (HMO) H5117-003 Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties


For HMO SNP Members:

Plan Name CMS# Parish Summary of Benefits
Allwell Dual Medicare
(HMO D-SNP)
H5117-004 Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties
Allwell Dual Medicare Essentials
(HMO D-SNP)
H5117-005 Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge 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 parish:

For HMO Members:

Plan Name CMS# Parish Evidence of Coverage 

Allwell Medicare (HMO)

 

H5117-003

Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties


For HMO SNP Members:

Plan Name CMS# Parish Evidence of Coverage
Allwell Dual Medicare
(HMO D-SNP)
H5117-004 Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties
Allwell Dual Medicare Essentials
(HMO D-SNP)
H5117 - 005 Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties

If you were enrolled in Allwell from Louisiana Healthcare Connections 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 parish:

For HMO Members:

Plan Name CMS# Parish Annual Notice of Changes
Allwell Medicare (HMO) H5117-003

Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties

Please select the document for your plan and parish:

For HMO Members:

Plan Name CMS# Parish Low Income Subsidy
Allwell Medicare (HMO) H5117-003 Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties


For HMO SNP Members:

Plan Name CMS# Parish Low Income Subsidy
Allwell Dual Medicare
(HMO D-SNP)
H5117-004 Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties
Allwell Dual Medicare Essentials
(HMO D-SNP)
H5117-005 Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties

This is the complete list of prescription drugs covered by Allwell.

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.

Please select the document for your plan and parish:

For HMO Members:

Plan Name CMS# Parish Extra Benefits Brochure
Allwell Medicare (HMO) H5117-003 Acadia, Ascension, East Baton Rouge, Iberville, Lafayette, Livingston, Pointe Coupee, St. James, St. Landry, St. Martin, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties


For HMO SNP Members:

Plan Name CMS# Parish Extra Benefits Brochure
Allwell Dual Medicare
(HMO D-SNP)
H5117-004 Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties
Allwell Dual Medicare Essentials
(HMO D-SNP)
H5117-005 Ascension, East Baton Rouge, Jefferson, Livingston, Orleans, Pointe Coupee, St. Tammany, Tangipahoa, Washington and West Baton Rouge counties
  • Beginners Guide to Medicare (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!