Plan Benefit Materials and Forms | Wellcare Nebraska
Explore your plan and its benefits by reviewing important documents like 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.”
Wellcare Giveback (HMO-POS) H1215-003
Counties: Adams, Antelope, Banner, Blaine, Boone, Buffalo, Burt, Butler, Cass, Clay, Colfax, Cuming, Custer, Dawson, Dodge, Douglas, Fillmore, Franklin, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hall, Hamilton, Harlan, Howard, Jefferson, Johnson, Kearney, Knox, Lancaster, Madison, Merrick, Nance, Nemaha, Otoe, Phelps, Pierce, Polk, Saline, Sarpy, Saunders, Scotts Bluff, Seward, Sherman, Stanton, Thayer, Valley, Washington, Wayne, Webster, Wheeler, York
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
Wellcare Simple (HMO-POS) H1215-005
Counties: Adams, Antelope, Banner, Blaine, Boone, Buffalo, Burt, Butler, Cass, Clay, Colfax, Cuming, Custer, Dawson, Dodge, Douglas, Fillmore, Franklin, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hall, Hamilton, Harlan, Howard, Jefferson, Johnson, Kearney, Knox, Lancaster, Madison, Merrick, Nance, Nemaha, Otoe, Phelps, Pierce, Polk, Saline, Sarpy, Saunders, Scotts Bluff, Seward, Sherman, Stanton, Thayer, Valley, Washington, Wayne, Webster, Wheeler, York
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
Wellcare Dual Liberty Sync (HMO-POS D-SNP) H1215-001
Counties: Adams, Antelope, Banner, Blaine, Boone, Boyd, Buffalo, Burt, Butler, Cass, Cedar, Clay, Colfax, Cuming, Custer, Dawson, Dixon, Dodge, Douglas, Fillmore, Franklin, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hall, Hamilton, Harlan, Hayes, Hitchcock, Holt, Howard, Jefferson, Johnson, Kearney, Keith, Knox, Lancaster, Lincoln, Logan, Madison, Merrick, Nance, Nemaha, Otoe, Pawnee, Perkins, Phelps, Pierce, Polk, Saline, Sarpy, Saunders, Scotts Bluff, Seward, Sherman, Stanton, Thayer, Valley, Washington, Wayne, Webster, Wheeler, York
Annual Notice of Change
- Annual Notice of Change - English (PDF)
- Annual Notice of Change - Spanish (PDF) - Coming Soon
Summary of Benefits
- Summary of Benefits - English (PDF)
- Summary of Benefits - Spanish (PDF) - Coming Soon
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Wellcare Assist Open (PPO) H1395-003
Counties: Adams, Antelope, Banner, Blaine, Boone, Buffalo, Burt, Butler, Cass, Clay, Colfax, Cuming, Custer, Dawson, Dodge, Douglas, Fillmore, Franklin, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hall, Hamilton, Harlan, Howard, Jefferson, Johnson, Kearney, Knox, Lancaster, Madison, Merrick, Nance, Nemaha, Otoe, Phelps, Pierce, Polk, Saline, Sarpy, Saunders, Scotts Bluff, Seward, Sherman, Stanton, Thayer, Valley, Washington, Wayne, Webster, Wheeler, York
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
Wellcare Patriot Giveback Open (PPO) H1395-004
Counties: Adams, Antelope, Banner, Blaine, Boone, Buffalo, Burt, Butler, Cass, Clay, Colfax, Cuming, Custer, Dawson, Dodge, Douglas, Fillmore, Franklin, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hall, Hamilton, Harlan, Howard, Jefferson, Johnson, Kearney, Knox, Lancaster, Madison, Merrick, Nance, Nemaha, Otoe, Phelps, Pierce, Polk, Saline, Sarpy, Saunders, Scotts Bluff, Seward, Sherman, Stanton, Thayer, Valley, Washington, Wayne, Webster, Wheeler, York
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
Wellcare Simple Open (PPO) H1395-002
Counties: Adams, Antelope, Banner, Blaine, Boone, Burt, Butler, Cass, Clay, Colfax, Cuming, Custer, Dodge, Douglas, Fillmore, Franklin, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hamilton, Harlan, Howard, Jefferson, Johnson, Knox, Lancaster, Madison, Merrick, Nance, Nemaha, Otoe, Pierce, Polk, Saline, Sarpy, Saunders, Scotts Bluff, Seward, Sherman, Stanton, Thayer, Valley, Washington, Wayne, Webster, Wheeler, York
Annual Notice of Change
Summary of Benefits
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
Wellcare Dual Access Sync Open (PPO D-SNP) H1395-001
Counties: Adams, Antelope, Banner, Blaine, Boone, Boyd, Buffalo, Burt, Butler, Cass, Cedar, Clay, Colfax, Cuming, Custer, Dawson, Dixon, Dodge, Douglas, Fillmore, Franklin, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hall, Hamilton, Harlan, Hayes, Hitchcock, Holt, Howard, Jefferson, Johnson, Kearney, Keith, Knox, Lancaster, Lincoln, Logan, Madison, Merrick, Nance, Nemaha, Otoe, Pawnee, Perkins, Phelps, Pierce, Polk, Saline, Sarpy, Saunders, Scotts Bluff, Seward, Sherman, Stanton, Thayer, Valley, Washington, Wayne, Webster, Wheeler, York
Annual Notice of Change
- Annual Notice of Change - English (PDF)
- Annual Notice of Change - Spanish (PDF) - Coming Soon
Summary of Benefits
- Summary of Benefits - English (PDF)
- Summary of Benefits - Spanish (PDF) - Coming Soon
Evidence of Coverage
- Evidence of Coverage - English (PDF) - Coming Soon
- Evidence of Coverage - Spanish (PDF) - Coming Soon
Dental Benefit Details
- Dental Benefit Details - English (PDF) - Coming Soon
- Dental Benefit Details - Spanish (PDF) - Coming Soon
Additional Forms
- Over-the-Counter Catalog (PDF) - Coming Soon
- Over-the-Counter Catalog and Healthy Food (PDF) - Coming Soon
- Medicare Step Therapy Part B (PDF) - Coming Soon
- 2026 Medicare Parts A & B Premiums and Deductibles (PDF) - Coming Soon
- Member Secure Portal Guide (PDF) - Coming Soon