Plan Benefit Materials | Allwell from Buckeye Health Plan
Plan Materials and Forms
Learn about your plan and all that it has to offer by reviewing helpful plan documents such as the Annual Notice of Change (ANOC), Summary of Benefits, and Evidence of Coverage.
To get started, locate your plan in the list of plans below and select “Plan Benefits.”
HMO
Wellcare Simple (HMO-POS) H0908-003
Counties: Adams, Allen, Ashland, Ashtabula, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, Wyandot
Annual Notice of Changes
- Annual Notice of Change – English (PDF) - Coming soon
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
Wellcare Assist (HMO-POS) H0908-004
Counties: Adams, Allen, Ashland, Ashtabula, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, Wyandot
Annual Notice of Changes
- Annual Notice of Change – English (PDF) - Coming soon
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
Wellcare Giveback (HMO-POS) H0908-005
Counties: Adams, Allen, Ashland, Ashtabula, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, Wyandot
Annual Notice of Changes
- Annual Notice of Change – English (PDF) - Coming soon
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
HMO D-SNP
Wellcare Dual Access (HMO-POS D-SNP) H0908-001
Counties: Adams, Allen, Ashland, Ashtabula, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, Wyandot
Annual Notice of Changes
- Annual Notice of Change: Wellcare All Dual Assure (HMO D-SNP) to Wellcare Dual Access (HMO-POS D-SNP) - English (PDF) - Coming soon
- Annual Notice of Change: Wellcare All Dual Assure (HMO D-SNP) to Wellcare Dual Access (HMO-POS D-SNP) - English (PDF) - Coming soon
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
Wellcare Dual Reserve (HMO-POS D-SNP) H0908-006
Counties: Adams, Allen, Ashland, Ashtabula, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, Wyandot
Annual Notice of Changes
- Annual Notice of Change – English (PDF) - Coming soon
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
PPO
Wellcare Simple Open (PPO) H7169-001
Counties: Adams, Allen, Ashland, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, Wyandot
Annual Notice of Changes
- Annual Notice of Change – English (PDF) - Coming soon
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
PPO D-SNP
Wellcare Dual Access Open (PPO D-SNP) H7169-003
Counties: Adams, Allen, Ashland, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, Wyandot
Annual Notice of Changes
- Annual Notice of Change – English (PDF) - Coming soon
Summary of Benefits
- Summary of Benefits – English (PDF) - Coming soon
Evidence of Coverage
- Evidence of Coverage – English (PDF) - Coming soon
- Dental Benefit Details – English (PDF) - Coming soon
Additional Forms
- Medicare Step Therapy Part B (PDF) - Coming soon
- Covered Diabetes Testing Supplies - Coming soon
- Over-the-Counter Catalog (PDF) - Coming soon
- Over-the-Counter Catalog and Healthy Food (PDF) - Coming soon
- 2026 Original Medicare Defined Cost Share Amounts and Premiums (PDF) - Coming soon