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.

Look at your Wellcare By Health Net member ID card for your plan number and type to view materials for your plan. 

  • View a sample of an Wellcare By Health Net Member ID Card to see where this information is located.

You can also look for plan materials based on the plan name and the county you live in.

If you don’t have a Wellcare By Health Net ID card or have questions about plan materials, give us a call. We’re here to help.

For HMO Members:

Plan CMS# County Summary of Benefits
Wellcare Plus Sapphire I (HMO) H0562 - 122
  • Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Clara, Stanislaus
Wellcare Assist (HMO) H0562 - 127
  • Amador, Contra Costa, Fresno, Madera, Santa Clara
Wellcare Plus Sapphire II (HMO) H3561-002
 
  • Alameda, Fresno, Imperial, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco, Tulare

Wellcare No Premium Ruby (HMO)
H0562 - 079
  • Fresno, Kern, Madera
Wellcare No Premium (HMO) H0562 - 090
  • Fresno
Wellcare No Premium (HMO) H0562 - 125
  • Los Angeles, Orange
Wellcare No Premium (HMO) H0562 - 120
  • Santa Clara, Stanislaus
Wellcare Premium Ultra (HMO) H0562 -009
  • Alameda, Amador, Contra Costa, San Francisco, Stanislaus
Wellcare Premium Ultra (HMO) H0562 - 084
  • Placer, Sacramento
Wellcare Premium Enhanced (HMO) H0562 - 039
  • Yolo
Wellcare No Premium (HMO) H0562 - 097
  • San Francisco
Wellcare No Premium (HMO) H0562 - 103
  • Amador, Contra Costa, Yolo
Wellcare No Premium (HMO) H0562 - 124
  • Placer, Sacramento
Wellcare No Premium (HMO) H0562 - 113
  • Alameda
Wellcare Patriot Giveback (HMO) H0562 - 044
  • Alameda, Amador, Contra Costa, Los Angeles, Placer, Riverside, Sacramento, San Bernardino, Stanislaus
Wellcare Low Premium (HMO) H0562 - 123
  • Los Angeles, Orange, Riverside, San Bernardino
Wellcare No Premium (HMO) H0562 - 012
  • Imperial, San Diego
Wellcare No Premium (HMO) H0562 - 126
  • Riverside, San Bernardino

For HMO DSNP and C SNP Members:

Plans CMS# County Summary of Benefits
Wellcare Dual Liberty (HMO D-SNP) H0562 - 121
  • Fresno, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco & Tulare
Wellcare Dual Liberty Amber (HMO D-SNP) H3561 - 001
  • Alameda, Amador, Fresno, Imperial, Madera, Placer, Sacramento, Stanislaus
Wellcare Specialty No Premium (HMO C-SNP) H0562 - 092
  • Kern, Los Angeles, Orange
Wellcare Specialty No Premium (HMO C-SNP) H0562 - 114
  • San Diego
Wellcare Specialty No Premium (HMO C-SNP) H0562 - 118
  • Fresno, San Francisco

For PPO Members:

Plan CMS# County Summary of Benefits
Wellcare No Premium Open (PPO) H7360-001
  • Amador, Sutter

 

For HMO Members

Plan CMS# County Evidence of Coverage
Wellcare Plus Sapphire I (HMO) H0562 - 122
  • Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Clara, Stanislaus
Wellcare Assist (HMO) H0562 - 127
  • Amador, Contra Costa, Fresno, Madera, Santa Clara
Wellcare Plus Sapphire II (HMO) H3561-002

 

  • Alameda, Fresno, Imperial, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco, Tulare

Wellcare No Premium Ruby (HMO)
H0562 - 079
  • Fresno, Kern, Madera
Wellcare No Premium (HMO) H0562 - 090
  • Fresno
Wellcare No Premium (HMO) H0562 - 125
  • Los Angeles, Orange
Wellcare No Premium (HMO) H0562 - 120
  • Santa Clara, Stanislaus
Wellcare Premium Ultra (HMO) H0562 -009
  • Alameda, Amador, Contra Costa, San Francisco, Stanislaus
Wellcare Premium Ultra (HMO) H0562 - 084
  • Placer, Sacramento
Wellcare Premium Enhanced (HMO) H0562 - 039
  • Yolo
Wellcare No Premium (HMO) H0562 - 097
  • San Francisco
Wellcare No Premium (HMO) H0562 - 103
  • Amador, Contra, Costa, Yolo
Wellcare No Premium (HMO) H0562 - 124
  • Placer, Sacramento 
Wellcare No Premium (HMO) H0562 - 113
  • Alameda
Wellcare Patriot Giveback (HMO) H0562 - 044
  • Alameda, Amador, Contra Costa, Los Angeles, Placer, Riverside, Sacramento, San Bernardino, Stanislaus
Wellcare Low Premium (HMO) H0562 - 123
  • Los Angeles, Orange, Riverside, San Bernardino
Wellcare No Premium (HMO) H0562 - 012
  • Imperial, San Diego
Wellcare No Premium (HMO) H0562 - 126
  • Riverside, San Bernardino

 

For HMO DSNP and C SNP Members

Plans CMS#    County  Evidence of Coverage
Wellcare Dual Liberty (HMO D-SNP) H0562 - 121
  • Fresno, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco & Tulare
Wellcare Dual Liberty Amber (HMO D-SNP) H3561 - 001
  • Alameda, Amador, Fresno, Imperial, Madera, Placer, Sacramento, Stanislaus

 

Wellcare Specialty No Premium (HMO C-SNP) H0562 - 092
  • Kern, Los Angeles, Orange
Wellcare Specialty No Premium (HMO C-SNP) H0562 - 114
  • San Diego
Wellcare Specialty No Premium (HMO C-SNP) H0562 - 118
  • Fresno, San Francisco

 

For PPO Members:

Plans CMS# County Evidence of Coverage
Wellcare No Premium Open (PPO) H7360-001
  • Amador, Sutter

 

For HMO Members

Plan CMS# County Annual Notice of Changes  (ANOC)
Wellcare Plus Sapphire I (HMO) H0562 - 122
  • Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Clara, Stanislaus
  • Annual Notice of Changes (ANOC), H0562 - 122 - Chinese (PDF) - coming soon

  • Annual Notice of Changes (ANOC), H0562 - 122 - Korean (PDF) - coming soon

  • Annual Notice of Changes (ANOC), H0562 - 122 - Vietnamese (PDF) - coming soon
Wellcare Plus Sapphire II (HMO) H3561-002
  • Alameda, Fresno, Imperial, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco, Tulare

Wellcare No Premium Ruby (HMO)
H0562 - 079
  • Fresno, Kern, Madera
Wellcare No Premium (HMO) H0562 - 090
  • Fresno
Wellcare No Premium (HMO) H0562 - 125
  • Los Angeles, Orange
Wellcare No Premium (HMO) H0562 - 120
  • Santa Clara, Stanislaus
Wellcare Premium Ultra (HMO) H0562 -009
  • Alameda, Amador, Contra Costa, San Francisco, Stanislaus
Wellcare Premium Ultra (HMO) H0562 - 084
  • Placer, Sacramento
  • Annual Notice of Changes (ANOC), H0562 - 084 - English (PDF)

  • Annual Notice of Changes (ANOC), H0562 - 084 - Spanish (PDF)

  • Annual Notice of Changes (ANOC), H0562 - 084 - Chinese (PDF) - coming soon

  • Annual Notice of Changes (ANOC), H0562 - 084 - Korean (PDF) - coming soon

  • Annual Notice of Changes (ANOC), H0562 - 084 - Vietnamese (PDF) - coming soon
Wellcare Premium Enhanced (HMO) H0562 - 039
  • Yolo
Wellcare No Premium (HMO) H0562 - 097
  • San Francisco
Wellcare No Premium (HMO) H0562 - 103
  • Amador, Contra Costa, Yolo
Wellcare No Premium (HMO) H0562 - 124
  • Placer, Sacramento
Wellcare No Premium (HMO) H0562 - 113
  • Alameda
Wellcare Patriot Giveback (HMO) H0562 - 044
  • Alameda, Amador, Contra Costa, Los Angeles, Placer, Riverside, Sacramento, San Bernardino, Stanislaus
Wellcare Low Premium (HMO) H0562 - 123
  • Los Angeles, Orange, Riverside, San Bernardino
  • Annual Notice of Changes (ANOC), H0562 - 123 - Chinese (PDF) - coming soon
Wellcare No Premium (HMO) H0562 - 012
  • Imperial, San Diego
Wellcare No Premium (HMO) H0562 - 126
  • Riverside, San Bernardino

For HMO DSNP and C SNP Members

Plans CMS# County Annual Notice of Changes (ANOC)
Wellcare Dual Liberty (HMO D-SNP) H0562 - 121
  • Fresno, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco & Tulare
Wellcare Dual Liberty Amber (HMO D-SNP) H3561 - 001
  • Alameda, Amador, Fresno, Imperial, Madera, Placer, Sacramento, Stanislaus
Wellcare Specialty No Premium (HMO C-SNP) H0562 - 092
  • Kern, Los Angeles, Orange
Wellcare Specialty No Premium (HMO C-SNP) H0562 - 114
  • San Diego
Wellcare Specialty No Premium (HMO C-SNP) H0562 - 118
  • Fresno, San Francisco

 

Wellcare Premium Ultra (HMO)

Riverside & San Bernardino

San Diego

Wellcare No Premium (HMO)

Yolo

Alameda & Stanislaus

Placer & Sacramento

Kern

Wellcare Premium Enhanced (HMO)

San Francisco

Wellcare Low Premium (HMO)

Alameda

Wellcare Patriot Giveback (HMO)

Fresno

Wellcare Specialty No Premium (HMO C-SNP)

Fresno, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco and Tulane