MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
Plan Benefit Materials | Health Net Medicare Advantage for California

Plan Materials and Forms
Information about plan benefits, services, and drug costs can be found in your plan materials.
You can also look for plan materials based on the plan name and the county you live in.
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 | CMS# | County | Summary of Benefits |
---|---|---|---|
Wellcare Premium Ultra (HMO) | H0562 -009 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 012 |
|
|
Wellcare Premium Ultra (HMO) | H0562 - 039 |
|
|
Wellcare No Premium Ruby (HMO) | H0562 - 079 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 097 |
|
|
Wellcare No Premium (HMO) | H0562 - 128 |
|
|
Wellcare Low Premium (HMO) | H0562 - 130 - 001 |
|
|
Wellcare Low Premium (HMO) | H0562 - 130 - 002 |
|
|
Wellcare No Premium Focus (HMO) | H0562-125 |
|
|
Wellcare No Premium Focus (HMO) | H0562-126 |
|
|
For HMO DSNP, C SNP, PPO and CalViva Members:
Plans | CMS# | County | Summary of Benefits |
---|---|---|---|
Wellcare Dual Liberty (HMO D-SNP) | H3561 - 001 |
|
|
Wellcare CalViva Health Dual Align (HMO D-SNP) | H3561 - 007 |
|
|
Wellcare Dual Align (HMO D-SNP) | H3561 - 008 |
|
|
Wellcare Dual Liberty (HMO D-SNP) | H3561 - 009 |
|
|
Wellcare Specialty No Premium (HMO C-SNP) | H0562 - 092 |
|
|
Wellcare No Premium Open (PPO) | H7360 - 001 |
|
|
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 | CMS# | County | Evidence of Coverage |
---|---|---|---|
Wellcare Premium Ultra (HMO) | H0562 -009 |
|
|
Wellcare No Premium (HMO) | H0562 - 012 |
|
|
Wellcare Premium Ultra (HMO) | H0562 - 039 |
|
|
Wellcare No Premium Ruby (HMO) | H0562 - 079 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 097 |
|
|
Wellcare No Premium (HMO) | H0562 - 128 |
|
|
Wellcare Low Premium (HMO) | H0562 - 130 - 001 |
|
|
Wellcare Low Premium (HMO) | H0562 - 130 - 002 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 125 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 126 |
|
|
For HMO DSNP, C SNP and PPO Members
Plans | CMS# | County | Evidence of Coverage |
---|---|---|---|
Wellcare Dual Liberty (HMO D-SNP) | H3561 - 001 |
|
|
Wellcare CalViva Health Dual Align (HMO D-SNP) | H3561 - 007 |
|
|
Wellcare Dual Align (HMO D-SNP) | H3561 - 008 |
|
|
Wellcare Dual Liberty (HMO D-SNP) | H3561 - 009 |
|
|
Wellcare Specialty No Premium (HMO C-SNP) | H0562 - 092 |
|
|
Wellcare No Premium Open (PPO) | H7360 - 001 |
|
|
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 | CMS# | County | Annual Notice of Changes (ANOC) |
---|---|---|---|
Wellcare No Premium Ruby (HMO) |
H0562 - 079 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 097 |
|
|
Wellcare No Premium (HMO) | H0562 - 128 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 125 |
|
|
Wellcare Low Premium (HMO) | H0562-123 to H0562-130-001 |
|
|
Wellcare Low Premium (HMO) | H0562-123 to H0562-130-002 |
|
|
Wellcare Premium Ultra (HMO) | H0562 -009 |
|
|
Wellcare Premium Ultra (HMO) | H0562 -084 to H0562 -009 |
|
|
Wellcare Premium Ultra (HMO) | H0562 - 039 |
|
|
Wellcare No Premium (HMO) | H0562 - 103 to H0562- 128 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 012 |
|
|
Wellcare No Premium Focus (HMO) | H0562 - 126 |
|
For HMO C-SNP
Plans | CMS# | County | Annual Notice of Changes (ANOC) |
---|---|---|---|
Wellcare Specialty No Premium (HMO C-SNP) | H0562 - 092 |
|
|
Wellcare Specialty No Premium (HMO C-SNP) | H0562-114 to H0562-092 |
|
For HMO DSNP
CMS# | County | Annual Notice of Changes (ANOC) | |
---|---|---|---|
Wellcare Dual Liberty (HMO D-SNP) to Wellcare Dual Liberty (HMO D-SNP) ) DSNP | H0562-121 to H3561-001 |
|
|
Wellcare Dual Liberty (HMO D-SNP) to Wellcare CalViva Health Dual Align (HMO D-SNP) | H0562 - 121 to H3561 - 007 |
|
|
Wellcare Dual Liberty Amber (HMO D-SNP) to Wellcare CalViva Health Dual Align (HMO D-SNP) | H3561 - 001 to H3561 - 007 |
|
|
Wellcare Dual Liberty (HMO D-SNP) to Wellcare Dual Align (HMO D-SNP) | H0562 - 121 to H3561 - 008 |
|
|
Wellcare Dual Liberty (HMO D-SNP) | H3561 - 001 |
|
|
Wellcare Dual Align 129 (HMO D-SNP) to Wellcare Dual Align (HMO D-SNP) | H0562-129 to H3561-008 |
|
|
Wellcare Dual Liberty Amber (HMO D-SNP) to Wellcare Dual Align (HMO D-SNP) | H3561-001 to H3561-008 |
|
|
Wellcare Dual Liberty (HMO D-SNP) to Wellcare Dual Liberty (HMO D-SNP) | H0562-121 to H3561-009 |
|
|
Wellcare Dual Align 129 (HMO D-SNP) to Wellcare Dual Liberty (HMO D-SNP) | H0562-129 to H3561-009 |
|
|
Wellcare Dual Liberty (HMO D-SNP) to Wellcare Dual Liberty (HMO D-SNP) | H5087-027 to H3561-001 |
|
|
Wellcare Dual Align 001 (HMO D-SNP) to Wellcare Dual Align (HMO D-SNP) | H5087-001 to H3561-008 |
|
For PPO
Plans | CMS# | County | Annual Notice of Changes (ANOC) |
---|---|---|---|
Wellcare No Premium Open (PPO) | H7360 - 001 |
|
- Dental Provider Form CA H0562 - English (PDF)
- Dental Provider Form CA H0562 - Chinese (PDF)
- Dental Provider Form CA H0562 - Spanish (PDF)
- Dental Provider Form CA DSNP H3561- English (PDF)
- Dental Provider Form CA DSNP H3561 - Armenian (PDF)
- Dental Provider Form CA DSNP H3561 - Arabic (PDF)
- Dental Provider Form CA DSNP H3561 - Cambodian (PDF)
- Dental Provider Form CA DSNP H3561 - Chinese (PDF)
- Dental Provider Form CA DSNP H3561 - Farsi (PDF)
- Dental Provider Form CA DSNP H3561 - Korean (PDF)
- Dental Provider Form CA DSNP H3561 - Russian (PDF)
- Dental Provider Form CA DSNP H3561 - Spanish (PDF)
- Dental Provider Form CA DSNP H3561 - Tagalog(PDF)
- Dental Provider Form CA DSNP H3561 - Vietanmese (PDF)