Plan Benefit Materials | Health Net Medicare Advantage for Oregon and Washington

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 PPO Members

Plans CMS# County  Summary of Benefits
Wellcare Patriot No Premium Open (PPO) H5439-010 Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
Wellcare Premium Ultra Open (PPO) H5439-011

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Wellcare Low Premium Open (PPO) H5439-018 Benton, Clackamas, Clark, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
Wellcare Low Premium Open (PPO) H5439-019 Douglas, Jackson, Josephine
Wellcare Giveback Open (PPO) H5439-015

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Wellcare No Premium Open (PPO) H5439-017

Lane

For HMO Members

Plans  CMS#  County  Summary of Benefits 
Wellcare No Premium (HMO)  H6815-038

Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, YamhillClackamas,
Multnomah & Washington

Wellcare Assist (HMO) H6815-037 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Douglas, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

For PPO Members

Plans CMS# County  Evidence of Coverage
Wellcare Patriot No Premium Open (PPO) H5439-010 Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
Wellcare Premium Ultra Open (PPO) H5439-011

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

 
Wellcare Low Premium Open (PPO) H5439-018 Benton, Clackamas, Clark, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
 
Wellcare Low Premium Open (PPO) H5439-019 Douglas, Jackson, Josephine

 

Wellcare Giveback Open (PPO) H5439-015

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

 
Wellcare No Premium Open (PPO) H5439-017

Lane

 

For HMO Members

Plans  CMS#  County  Evidence of Coverage 
Wellcare No Premium (HMO)  H6815-038

Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, YamhillClackamas,
Multnomah & Washington

Wellcare Assist (HMO) H6815-037 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Douglas, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

For PPO Members

Plans CMS# County Low Income Subsidy
Wellcare Patriot No Premium Open (PPO) H5439-010 Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
Wellcare Premium Ultra Open (PPO) H5439-011 Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

 

Wellcare Giveback Open (PPO) H5439-015 Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

 

Wellcare No Premium Open (PPO) H5439-017 Lane

 

Wellcare Low Premium Open (PPO) H5439-018 Benton, Clackamas, Clark, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhillc
Wellcare Low Premium Open (PPO) H5439-019 Douglas, Jackson, Josephine

For HMO Members

Plans CMS# County Annual Notice of Changes
Wellcare Assist (HMO) H6815-037 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Douglas, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
Wellcare No Premium (HMO) H6815-038 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, YamhillClackamas,
Multnomah & Washington
Health Net Ruby (HMO) to Wellcare No Premium (HMO) H6815-005 - H6815-038 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill, Clackamas,
Multnomah & Washington
Health Net Ruby (HMO) to Wellcare No Premium (HMO) H6815-006 - H6815-038 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, YamhillClackamas,
Multnomah & Washington