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2024 Mississippi - Why Wellcare?

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All Major Hospital systems in Central and South MS
NEW - Up to $210/mo Spendables Card Includes Pay-at-the-Pump Gas, Utilities, Rent, Healthy Food, D/V/H and OTC – monthly rolling
NEW – Competitive All Dual plan for partial Duals

Competitive Giveback MAPD in Mississippi - $61/mo

Up to $4k comp dental services – includes no prev max
Transportation reimbursement option - .67/mi

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Table of Contents

2

3 | Centene At A Glance

4 | State Overview

9 | Medicare Advantage Portfolio Approach

14 | Strategic Alliances

16 | PY2024 Products

34 | Supplemental Benefits

49 | Value-Based Insurance Design

51 | Pharmacy

54 | Prescription Drug Plan

59 | Broker Experience Enhancements

66 | Member Experience Enhancements

69 | Quick Reference

72 | Appendix

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Centene At A Glance

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State Overview

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Overview

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Significant investment in D-SNP (HMO/PPO) plans

Up to $210/month rolling Wellcare Spendables™ Card

All major hospitals in Central and Gulf Coast in network

Baptist, UMC, St. Dominic, Merit, Singing River, and Memorial (recently contracted)

Strong local partnerships with providers, churches, food pantries, non-profits, and senior centers
2024 new product expansion:

Competitive All Duals Plan built for partial duals

Service Area

Wellcare MAPD Continued Coverage Counties:

Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, Desoto, Forrest, George, Greene, Grenada, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson, Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

HMO, HMO D-SNP, HMO-POS HMO, HMO D-SNP, HMO-POS, PPO, PPO D-SNP

Wellcare MAPD

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Subregion Map

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Provider Network

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Provider network subject to change. Please utilize the Find a Provider tool for the most up-to-date network information.

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The Team

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Name	Title	Supporting Market	Phone Number	Email
BJ Thompsoⁿ	Regional Agency Manager	North/Central	601-715‐0746	bruce.thompson@wellcare.com
Cheryl Smith	Regional Agency Manager	Central	601-397-8769	chersmith@wellcare.com
Janine Harges	Regional Agency Manager	Gulf Coast	601-715‐9369	jharges@wellcare.com

Please visit WellcareFirstLook.com for the most up-to-date local contact information.

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Medicare Advantage Portfolio Approach

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Portfolio Approach

Traditional Medicare Advantage

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Products	Product Examples	Target Market
Part B Premium Giveback	Wellcare Giveback	Value-conscious beneficiaries who are seeking some or all of the Part B premium back, are willing to trade off other benefits for the giveback, and do not qualify for payment of Part B premium by Medicaid HMO option available
$0 Premium	Wellcare No Premium Wellcare No Premium Open	Value-conscious beneficiaries who are seeking predictable copays and extra benefits HMO and LPPO options available
Part D Premium (LIS)	Wellcare Assist	Beneficiaries who receive Extra Help on Part D from the federal government but don’t qualify for a zero cost-share D-SNP and are seeking richer benefits than offered on a $0 premium plan Part D premium is paid by the Extra Help they receive HMO option available
Low Premium	Wellcare Low Premium	Beneficiaries who are not receiving Extra Help but are seeking rich medical and extra benefits for a premium between $1-49 HMO-POS option available
MA only	Wellcare Patriot Giveback	Beneficiaries who receive credible Part D coverage through a retiree plan, VA benefits, etc. Some plans also include giveback of some of the Part B premium HMO-POS options available

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Portfolio Approach

Special Needs Plan

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Products	Product Examples	Target Market
Zero Cost-Share D-SNP – Fully Eligible Medicare/ Medicaid	^{Wellcare Dual}Liberty	^{Cost-share protected beneficiaries who qualify for}Medicaid cost-sharing protection and full state benefits ^{Member does not pay for Medicare-covered medical}benefit cost-shares, but does pay Part D LIS copays ^{FBDE, SLMB+, QMB+}
Zero Cost-Share D-SNP – Cost-Share Protected Duals in each state	^{Wellcare Dual}Access ^{Wellcare Dual}Access Open	^{Cost-share protected beneficiaries who qualify for Medicaid}cost-sharing protection, but NOT for extra benefits from state ^{Member does not pay for Medicare-covered medical}benefit cost-shares, but does pay Part D LIS copays ^{FBDE, SLMB+, QMB+, QMB}
NEW Non-Zero D-SNP – All MSP Levels allowed in each state	^{Wellcare All Dual}Assure	^{Members who qualify for partial Medicaid but not}Medicare medical cost-share protection ^{Eligibility for Medicare plan is as follows: SLMB, QI, QDWI}(potentially other MSP levels depending on state eligibility criteria) ^{Accepts all Duals regardless of MSP level}

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2024 D-SNP Portfolio Approach

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Dual plans will have a consistent structure of MSP eligibility levels across plans.

STRUCTURE

Target populations by plan:

Liberty – full dual cost-share protected MSPs
Access – full dual cost-share protected MSPs – specifically QMB
All Dual Assure - partial MSPs – SLMB only, QDWI, and QI

MSP Revenue Legend:

QMB+, SLMB+, and FBDE*: High revenue, full cost-share protection

QMB: Lower revenue, full cost-share protection

SLMB only, QDWI, and QI: Lowest revenue, not cost-share protected

*State nuances may occur – MSP may not be cost-share protected

Liberty

MSP: QMB+, SLMB+, and FBDE

1

Access

MSP: QMB, QMB+, SLMB+, and FBDE

2

All Dual Assure

MSP: QMB, QMB+, SLMB+, FBDE,

SLMB only, QDWI, and QI

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All Dual Assure Plan Design:

Plans will include rich supplemental benefits
New All Dual plans will target partial duals who are not cost-share protected
HMO plans offered
All Dual Assure (copay A/B benefits) select markets

Plan Offering	States
Wellcare All Dual Assure (HMO D-SNP)	MS H1416

3

PY2024 NEW All Dual Plan Offerings

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Low Income Subsidy Plans

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Low Income Subsidy (LIS) plans specifically designed to work with the government’s LIS program
More meaningful medical and supplemental benefits to focus on members’ overall health, as prescription needs are addressed by the subsidy
Ideal for beneficiaries who receive Extra Help for Part D from the government, but do not qualify for a zero cost-share D-SNP and are seeking richer benefits than those offered by a $0 premium plan
Partial duals should consider All Dual plans in states where they are offered for additional competitive benefits.
NEW for 2024 – People who have incomes up to 150% of poverty and resources at or below the limits for partial LIS benefits are now eligible for full LIS benefits!

It is important to understand LIS status at the point of enrollment

in order to properly articulate premium, deductible, and copays, and get members into the best plan for them.

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Strategic Alliances

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The American Legion

Official Medicare Advantage Provider of The American Legion

Exclusive Medicare rights

2023 Activation

The American Legion National Convention – Aug. 25
Legion post communication and events
AEP marketing

2024 Strategy

Strategic marketing/brand plan
Capitalize on local post engagement
Leverage NASCAR partnership
National education events

Demographics

1.6 million total Legionnaires

72.84% over the age of 65

Total targeted population – 1,165,440
Wellcare targeted population – 978,000
Wellcare Patriot targeted population – 470,000

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PY2024 Products

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Sales Strategy/ Marketing Treatment Definitions

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Push	Plans that have been identified as primary growth driver plans All new plans Plans that need to be highlighted (e.g., those with new or interesting benefits, high benefit investment plans, anticipated enrollment YOY)
Normal	Run the business drivers Majority of the plans (approximately 85% of the plans)

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Product Portfolio

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Product Space	Contract Number	Plan Name	Contract Type	Key Benefits
$0 Premium	H0074001000	Wellcare No Premium Open	PPO	Multi-wallet benefit including dental, vision, hearing, and OTC $0 Premium Vision Dental with dentures and crowns Gap coverage
	H1416070000	Wellcare No Premium	HMO	Multi-wallet benefit including dental, vision, hearing, and OTC Dental with dentures and crowns $0 Premium PCP $0 Gap coverage
	H1416071000	Wellcare No Premium	HMO	Multi-wallet benefit including dental, vision, hearing, and OTC Dental with dentures and crowns $0 Premium PCP $0 Gap coverage
	PUSH Plan H1416072000	Wellcare No Premium	HMO	Multi-wallet benefit including dental, vision, hearing, and OTC Dental with dentures and crowns $0 Premium PCP $0 Gap coverage
Low-Moderate Premium	H1416026000	Wellcare Low Premium	HMO-POS	Dental with dentures and crowns OTC allowance Rx deductible $0 PCP $0 Vision
Giveback	H1416065000	Wellcare Giveback	HMO	Giveback Dental Vision PCP $0 OTC allowance
MA Only	H1416060000	Wellcare Patriot Giveback	HMO-POS	Giveback OTC allowance Dental with dentures and crowns Vision Transportation, Non-emergency

Agent use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination.

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Product Portfolio

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Product Space	Contract Number	Plan Name	Contract Type	Key Benefits
LIS	PUSH Plan H1416068000	Wellcare Assist	HMO	Multi-wallet benefit including dental, vision, hearing, and OTC Dental with dentures and crowns Vision Transportation, Non-emergency PCP $0
Zero Cost-Share D-SNP	PUSH Plan H1416044000	Wellcare Dual Liberty	HMO D- SNP	Multi-wallet benefit including dental, vision, hearing, OTC, groceries, utilities, and rent assistance Dental with dentures and crowns Vision Transportation, Non-emergency In-Home Support Services
	PUSH Plan H1416034000	Wellcare Dual Access	HMO D- SNP	Multi-wallet benefit including dental, vision, hearing, OTC, groceries, utilities, and rent assistance Dental with dentures and crowns Vision Transportation, Non-emergency In-Home Support Services
	PUSH Plan H0074004000	Wellcare Dual Access Open	PPO D-SNP	Multi-wallet benefit including dental, vision, hearing, OTC, groceries, utilities, and rent assistance Dental with dentures and crowns Hearing Vision Transportation, Non-emergency
	NEW PUSH Plan H1416081000	Wellcare All Dual Assure	HMO D- SNP	Multi-wallet benefit including dental, vision, hearing, OTC, groceries, utilities, and rent assistance Dental with dentures and crowns Vision Transportation, Non-emergency PCP $0

Agent use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination.

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Product Portfolio

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Product Space	Contract Number	Plan Name	Contract Type	Key Benefits
PDP	PUSH Plan S4802074000	Wellcare Classic	PDP	Designed for Duals (LIS) $0 Tier 1 (after deductible if applicable) at preferred pharmacies New $0 drug tier added with medications commonly used to treat diabetes
	PUSH Plan S4802154000	Wellcare Value Script	PDP	Low Premium No deductible on Tier 1 and 2 medications (preferred generic and generic) $0 copay for Tier 1 drugs at preferred pharmacies
	PUSH Plan S4802223000	Wellcare Medicare Rx Value Plus	PDP	No deductible for all tiers $0 copay for Tier 1 drugs at preferred pharmacies Low-cost drug tier designed for medications commonly used to treat diabetes

Agent use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination.

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HMO Plans

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Wellcare Giveback (HMO) | H1416065000

Product Space	Giveback MAPD
IN/OON/Tier	In Network
Qualifying Chronic Conditions	N/A
Premium Part B Giveback	$61
Total Premium (Part C Part D)	$0
Plan Deductible	$240
Maximum Out of Pocket (MOOP) – INN	$6,700
Maximum Out of Pocket (MOOP) – OON/Combined	N/A
Inpatient Acute	$475 copay per day for days 1-4; $0 copay per day for days 5-90; $0 copay for unlimited additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$45
Medically Necessary Transportation	N/A
Wellcare Spendables™	OTC allowance of $40 every quarter ($160 every year) for covered items
In-Home Support Services – Frequency	N/A
Meals	N/A
Fitness	$0
Personal Emergency Response System (PERS)	N/A
Dental Benefits	No annual preventive max ($0 copay) - Bronze
Vision Benefits	$100 eyewear allowance
Hearing Benefits	$350 per ear every year
RX Deductible/Tiers	$545 on Tiers 3-5
RX Drug Copays (Tier 1-6)	$0 / $5 / $42 / 50% / 25% / $0
Lab Services	$0 - $50
X-Ray Services	$0
Target Market	Do not receive Extra Help and seek rich medical and extra benefits for a premium
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Grenada, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

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HMO Plans

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Wellcare Assist (HMO) | H1416068000

Product Space	LIS
IN/OON/Tier	In Network
Qualifying Chronic Conditions	N/A
Premium Part B Giveback	$0
Total Premium (Part C Part D)	$24.90
Plan Deductible	No
Maximum Out of Pocket (MOOP) – INN	$5,500
Maximum Out of Pocket (MOOP) – OON/Combined	N/A
Inpatient Acute	$325 copay per day for days 1-5; $0 copay per day for days 6-90; No additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$30
Medically Necessary Transportation	36 one-way trips every year
Wellcare Spendables™	Single allowance for OTC and/or additional Dental, Vision, and Hearing services of $35 every month ($420 every year)
In-Home Support Services – Frequency	N/A
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	N/A
Dental Benefits	No annual preventive max + $1,500 comp dental services including dentures ($0 copay) - Silver
Vision Benefits	$200 eyewear allowance
Hearing Benefits	$1,000 per ear every year
RX Deductible/Tiers	$440 on Tiers 2-5
RX Drug Copays (Tier 1-6)	$0 / $20 / $47 / 46% / 25% / $0
Lab Services	$0 - $50
X-Ray Services	$0
Target Market	Do not receive Extra Help and seek rich medical and extra benefits for a premium
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Grenada, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

PUSH Plan

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HMO Plans

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Wellcare No Premium (HMO) | H1416070000

Product Space	$0 Premium MAPD
IN/OON/Tier	In Network
Qualifying Chronic Conditions	N/A
Premium Part B Giveback	$0
Total Premium (Part C Part D)	$0
Plan Deductible	No
Maximum Out of Pocket (MOOP) – INN	$6,400
Maximum Out of Pocket (MOOP) – OON/Combined	N/A
Inpatient Acute	$300 copay per day for days 1-6; $0 copay per day for days 7-90; No additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$35
Medically Necessary Transportation	N/A
Wellcare Spendables™	Single allowance for OTC and/or additional Dental, Vision, and Hearing services of $29 every month ($348 every year)
In-Home Support Services – Frequency	N/A
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	N/A
Dental Benefits	No annual preventive max + $2,000 comp dental services including dentures ($0 copay) - Silver
Vision Benefits	$200 eyewear allowance
Hearing Benefits	$500 per ear every year
RX Deductible/Tiers	$275 on Tiers 4-5
RX Drug Copays (Tier 1-6)	$0 / $5 / $42 / 50% / 29% / $0
Lab Services	$0 - $50
X-Ray Services	$0
Target Market	Do not receive Extra Help and seek rich medical and extra benefits for a premium
DeSoto, Marshall, Panola, Tate, Tunica

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HMO Plans

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Wellcare No Premium (HMO) | H1416071000

Product Space	$0 Premium MAPD
IN/OON/Tier	In Network
Qualifying Chronic Conditions	N/A
Premium Part B Giveback	$0
Total Premium (Part C Part D)	$0
Plan Deductible	No
Maximum Out of Pocket (MOOP) – INN	$5,900
Maximum Out of Pocket (MOOP) – OON/Combined	N/A
Inpatient Acute	$300 copay per day for days 1-6; $0 copay per day for days 7-90; No additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$35
Medically Necessary Transportation	N/A
Wellcare Spendables™	Single allowance for OTC and/or additional Dental, Vision, and Hearing services of $27 every month ($324 every year)
In-Home Support Services – Frequency	N/A
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	$0
Dental Benefits	No annual preventive max + $2,000 comp dental services including dentures ($0 copay) - Silver
Vision Benefits	$100 eyewear allowance
Hearing Benefits	$500 per ear every year
RX Deductible/Tiers	$375 on Tiers 3-5
RX Drug Copays (Tier 1-6)	$0 / $10 / $42 / 50% / 27% / $0
Lab Services	$0 - $50
X-Ray Services	$10
Target Market	Do not receive Extra Help and seek rich medical and extra benefits for a premium
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, Forrest, Greene, Grenada, Hinds, Holmes, Humphreys, Issaquena, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Montgomery, Neshoba, Newton, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

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HMO Plans

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Wellcare No Premium (HMO) | H1416072000

Product Space	$0 Premium MAPD
IN/OON/Tier	In Network
Qualifying Chronic Conditions	N/A
Premium Part B Giveback	$0
Total Premium (Part C Part D)	$0
Plan Deductible	No
Maximum Out of Pocket (MOOP) – INN	$5,900
Maximum Out of Pocket (MOOP) – OON/Combined	N/A
Inpatient Acute	$300 copay per day for days 1-6; $0 copay per day for days 7-90; No additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$35
Medically Necessary Transportation	N/A
Wellcare Spendables™	Single allowance for OTC and/or additional Dental, Vision, and Hearing services of $29 every month ($348 every year)
In-Home Support Services – Frequency	N/A
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	N/A
Dental Benefits	No annual preventive max + $2,000 comp dental services including dentures ($0 copay) - Silver
Vision Benefits	$200 eyewear allowance
Hearing Benefits	$500 per ear every year
RX Deductible/Tiers	$275 on Tiers 4-5
RX Drug Copays (Tier 1-6)	$0 / $5 / $42 / 50% / 29% / $0
Lab Services	$0 - $50
X-Ray Services	$0
Target Market	Do not receive Extra Help and seek rich medical and extra benefits for a premium
George, Hancock, Harrison, Jackson

PUSH Plan

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HMO Plans

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Wellcare Low Premium (HMO-POS) | H1416026000

Product Space	$1-$49 Premium MAPD
IN/OON/Tier	In Network
Qualifying Chronic Conditions	N/A
Premium Part B Giveback	$0
Total Premium (Part C Part D)	$30
Plan Deductible	No
Maximum Out of Pocket (MOOP) – INN	$6,700
Maximum Out of Pocket (MOOP) – OON/Combined	$6,700 Combined
Inpatient Acute	$300 copay per day for days 1-5; $0 copay per day for days 6-90; No additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$35
Medically Necessary Transportation	N/A
Wellcare Spendables™	OTC allowance of $76 every quarter ($304 every year) for covered items
In-Home Support Services – Frequency	N/A
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	N/A
Dental Benefits	No annual preventive max + $1,500 comp dental services including dentures ($0 copay) - Silver
Vision Benefits	$200 eyewear allowance
Hearing Benefits	$500 per ear every year
RX Deductible/Tiers	$0
RX Drug Copays (Tier 1-6)	$0 / $5 / $42 / 50% / 33% / $0
Lab Services	$0 - $50
X-Ray Services	$0
Target Market	Do not receive Extra Help and seek rich medical and extra benefits for a premium
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Grenada, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

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HMO Plans

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Wellcare Patriot Giveback (HMO-POS) | H1416060000

Product Space	Giveback MA Only
IN/OON/Tier	In Network
Qualifying Chronic Conditions	N/A
Premium Part B Giveback	$50
Total Premium (Part C Part D)	$0
Plan Deductible	No
Maximum Out of Pocket (MOOP) – INN	$4,500
Maximum Out of Pocket (MOOP) – OON/Combined	$4,500 Combined
Inpatient Acute	$350 copay per day for days 1-5; $0 copay per day for days 6-90; No additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$35
Medically Necessary Transportation	36 one-way trips every year
Wellcare Spendables™	OTC allowance of $82 every quarter ($328 every year) for covered items
In-Home Support Services – Frequency	N/A
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	$0
Dental Benefits	No annual preventive max + $2,000 comp dental services including dentures ($0 copay) - Silver
Vision Benefits	$200 eyewear allowance
Hearing Benefits	$750 per ear every year
RX Deductible/Tiers	N/A
RX Drug Copays (Tier 1-6)	N/A
Lab Services	$0 - $50
X-Ray Services	$0
Target Market	Do not receive Extra Help and seek rich medical and extra benefits for a premium
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Grenada, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

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D-SNPs

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Wellcare Dual Access (HMO D-SNP) | H1416034000

Product Space	D-SNP – Full
IN/OON/Tier	In Network
MSP Levels	FBDE, SLMB+, QMB+, QMB
Total Premium (Part C Part D)	$0
Plan Deductible	$0
Maximum Out of Pocket (MOOP) – INN	$8,850
Maximum Out of Pocket (MOOP) – OON/Combined	N/A
Inpatient Acute	$0 copay up to 90 days per admission; $0 copay for 30 additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$0
Medically Necessary Transportation	60 one-way trips every year
Wellcare Spendables™	Single allowance for Gas Pay-at-Pump, Healthy Food, Utilities Assistance, Rent Assistance, OTC and additional Dental, Vision, Hearing services of $180 every month ($2,160 every year)
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	$0
In-Home Support Services - Frequency	Chores - 12 visits every year
Dental Benefits	No annual preventive max + $3,000 comp dental services including dentures ($0 copay) - Gold
Vision Benefits	$200 eyewear allowance
Hearing Benefits	$1,000 per ear every year
RX Deductible/RX Drug Copays (Tiers 1 -6) (Pref)	$0 / $0 All Covered Drugs
Target Market	Qualify for Medicaid cost-sharing protection, but NOT for extra benefits from the state
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Grenada, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

PUSH Plan

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D-SNPs

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Wellcare Dual Liberty (HMO D-SNP) | H1416044000

Product Space	D-SNP – Full
IN/OON/Tier	In Network
MSP Levels	FBDE, SLMB+, QMB+
Total Premium (Part C Part D)	$0
Plan Deductible	$0
Maximum Out of Pocket (MOOP) – INN	$8,850
Maximum Out of Pocket (MOOP) – OON/Combined	N/A
Inpatient Acute	$0 copay up to 90 days per admission; $0 copay for 30 additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$0
Medically Necessary Transportation	Unlimited trips every year
Wellcare Spendables™	Single allowance for Gas Pay-at-Pump, Healthy Food, Utilities Assistance, Rent Assistance, OTC and additional Dental, Vision, Hearing services of $210 every month ($2,520 every year)
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	$0
In-Home Support Services - Frequency	Chores - 12 visits every year
Dental Benefits	No annual preventive max + $4,000 comp dental services including dentures ($0 copay) - Gold
Vision Benefits	$400 eyewear allowance
Hearing Benefits	$2,000 per ear every year
RX Deductible/RX Drug Copays (Tiers 1 -6) (Pref)	$0 / $0 All Covered Drugs
Target Market	Qualify for Medicaid cost-sharing protection and full state benefits
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Grenada, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

PUSH Plan

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D-SNPs

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Wellcare All Dual Assure (HMO D-SNP) | H1416081000

Product Space	D-SNP – Partial
IN/OON/Tier	In Network
MSP Levels	FBDE, QDWI, QI, QMB+, QMB, SLMB+, SLMB
Total Premium (Part C Part D)	$0 - $20.40
Plan Deductible	No
Maximum Out of Pocket (MOOP) – INN	$5,500
Maximum Out of Pocket (MOOP) – OON/Combined	N/A
Inpatient Acute	$0 - $300 copay per day for days 1-5; $0 copay per day for days 6-90; No additional hospital days
PCP Office Visits	$0
Specialist Office Visits	$0 - $30
Medically Necessary Transportation	36 one-way trips every year
Wellcare Spendables™	Single allowance for Gas Pay-at-Pump, Healthy Food, Utilities Assistance, Rent Assistance, OTC and additional Dental, Vision, Hearing services of $40 every month ($480 every year)
Meals	Post-Acute Meals
Fitness	$0
Personal Emergency Response System (PERS)	N/A
In-Home Support Services - Frequency	N/A
Dental Benefits	No annual preventive max + $2,000 comp dental services including dentures ($0 copay) - Silver
Vision Benefits	$300 eyewear allowance
Hearing Benefits	$1,000 per ear every year
RX Deductible/RX Drug Copays (Tiers 1 -6) (Pref)	$0 / $0 All Covered Drugs
Target Market	Qualify for partial Medicaid but not Medicare medical cost-share protection; plan accepts all MSP levels
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Grenada, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

NEW PUSH Plan

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D-SNPs

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Wellcare Dual Access Open (PPO D-SNP) | H0074004000

Product Space	D-SNP – Full	D-SNP – Full
IN/OON/Tier	In Network	Out of Network
MSP Levels	FBDE, SLMB+, QMB+, QMB	FBDE, SLMB+, QMB+, QMB
Total Premium (Part C Part D)	$0	$0
Plan Deductible	$0	$0 or $240
Maximum Out of Pocket (MOOP) – INN	$8,850	N/A
Maximum Out of Pocket (MOOP) – OON/Combined	$13,300 (Combined)	$13,300 (Combined)
Inpatient Acute	$0 copay up to 90 days per admission	$0 - 20% of the total cost for days 1-90
PCP Office Visits	$0	$0 - 20%
Specialist Office Visits	$0	$0 - 20%
Medically Necessary Transportation	Unlimited trips every year	Unlimited trips every year
Wellcare Spendables™	Single allowance for Gas Pay-at-Pump, Healthy Food, Utilities Assistance, Rent Assistance, OTC and additional Dental, Vision, Hearing services of $100 every month ($1,200 every year)
Meals	Post-Acute Meals	Post-Acute Meals
Fitness	$0	$0
Personal Emergency Response System (PERS)	$0	$0
In-Home Support Services – Frequency	N/A	N/A
Dental Benefits	No annual preventive max + $4,000 comp dental services including dentures ($0 copay) - Gold	No annual preventive max + $4,000 comp dental services including dentures (50% cost-share) - Gold
Vision Benefits	$400 eyewear allowance	$400 eyewear allowance
Hearing Benefits	$1,000 per ear every year	$1,000 per ear every year
RX Deductible/RX Drug Copays (Tiers 1 -6) (Pref)	$0 / $0 All Covered Drugs	$0 / $0 All Covered Drugs
Target Market	Qualify for Medicaid cost-sharing protection, but NOT for extra benefits from the state
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

PUSH Plan

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PPO Plans

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Wellcare No Premium Open (PPO) | H0074001000

Product Space	$0 Premium MAPD	$0 Premium MAPD
IN/OON/Tier	In Network	Out of Network
Qualifying Chronic Conditions	N/A	N/A
Premium Part B Giveback	$0	$0
Total Premium (Part C Part D)	$0	$0
Plan Deductible	No	No
Maximum Out of Pocket (MOOP) – INN	$6,000	N/A
Maximum Out of Pocket (MOOP) – OON/Combined	$8,950 Combined	$8,950 Combined
Inpatient Acute	$295 copay per day for days 1-6; $0 copay per day for days 7-90; No additional hospital days	30% of the total cost for days 1-90
PCP Office Visits	$0	30%
Specialist Office Visits	$40	30%
Medically Necessary Transportation	N/A	N/A
Wellcare Spendables™	Single allowance for OTC and/or additional Dental, Vision, and Hearing services of $22 every month ($264 every year)
In-Home Support Services – Frequency	N/A	N/A
Meals	Post-Acute Meals	Post-Acute Meals
Fitness	$0	$0
Personal Emergency Response System (PERS)	N/A	N/A
Dental Benefits	No annual preventive max + $1,500 comp dental services including dentures ($0 copay) - Silver	No annual preventive max + $1,500 comp dental services including dentures (50% cost-share) - Silver
Vision Benefits	$300 eyewear allowance	$300 eyewear allowance
Hearing Benefits	$500 per ear every year	$500 per ear every year
RX Deductible/Tiers	$250 on Tiers 3-5	$250 on Tiers 3-5
RX Drug Copays (Tier 1 -6)	$0 / $0 / $42 / 50% / 29% / $0	$0 / $0 / $42 / 50% / 29% / $0
Lab Services	$0 - $50	30%
X-Ray Services	$0	30%
Target Market	Do not receive Extra Help and seek rich medical and extra benefits for a premium
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, George, Greene, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Jackson, Jasper, Jefferson Davis, Jones, Kemper, Lauderdale, Lawrence, Leake, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Neshoba, Newton, Panola, Perry, Pike, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yalobusha, Yazoo

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Agent of Record Promise

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Agent of Record Promise:

When an existing client makes a plan change by calling Wellcare directly, your AOR status will remain

unchanged. This means you will remain the AOR and continue to receive renewal commissions on plan changes. This even applies to plan changes from PDP to MAPD, where applicable. The Agent of Record Promise benefits your book of business year-round.

The Agent of Record Promise applies to:

Active certified 1099 contracted agents at the time of the member’s plan change.
All current and future Wellcare MA, MAPD, or PDP members in your book of business.
Plan changes facilitated through external Wellcare-appointed call center agent/agency.

Examples of the AOR remaining the same and renewal commissions being paid for the new plan as long as the member remains active:

An existing member calls Wellcare directly and changes from a MAPD plan to a different MAPD plan
An existing member calls Wellcare directly and changes from a PDP plan to a different PDP plan
An existing member calls Wellcare directly and changes from a PDP plan to a MAPD plan
A Wellcare-appointed call center calls a member to facilitate a plan change that benefits the member

For example: When a member is enrolled in an MAPD plan and is eligible for a D-SNP plan

A Wellcare-appointed call center calls a member who is impacted by a service area or benefit reduction, and they select a new plan

The Agent of Record Promise does NOT apply to:

Another active certified 1099 contracted agent who facilitates a plan change.

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Supplemental Benefits

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2024 MAPD Benefit Highlights

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Benefit	Availability	Highlight	Contact Info
Wellcare Spendables™ Card	All plans	D-SNPs include OTC, Gas Pay-at-Pump, utilities assistance, rent assistance, healthy food, and depending on the plan, additional Dental, Vision, and Hearing cost-sharing assistance, in one purse. Non-D-SNP plans can include OTC, and depending on the plan, additional Dental, Vision, and Hearing cost- sharing assistance, in one purse. Dental, Vision, and Hearing cost-sharing assistance is separate from routine base benefits.	Solutran: 855-744-8550
Routine Dental Base Benefit	All plans	In 2024, Wellcare will offer dental packages as lean as limited preventive services to preventive and comprehensive coverage, with various allowances depending on the plan. Allowance amounts for comprehensive services are up to $4,000. Service and periodicity limits apply.	DentaQuest: 833-206-6293
Routine Vision Base Benefit	All plans	Wellcare will offer packages in 2024 ranging from a routine exam only to routine exam plus an eyewear (glasses/contacts) allowance. Eyewear allowances range from $100 to $400. Members can get unlimited contacts and glasses with upgrades, up to the allowance maximum on their plan.	Premier: 833-611-7778
Routine Hearing Base Benefit	All plans	Wellcare will offer packages in 2024 ranging from coverage for routine exam only to routine exam and hearing aid coverage. Hearing aid allowances range from $350 per ear up to $2,000 per ear.	HCS: 866-344-7756
Non-Emergency Medical Transportation (NEMT)	Some plans	Wellcare will offer packages in 2024 ranging from coverage of 36 one-way trips to unlimited one-way trips. Trips can be used for non-emergency medically necessary reasons such as going to a doctor’s appointment or a pharmacy.	MTM: 844-524-1401
Fitness	All plans	Wellcare will cover a fitness membership on almost every Medicare Advantage plan being offered in 2024. Members can manage their health through online courses, in-home fitness kits, memory kits, and/or fitness trackers.	ASH: 877-427-4744
Personal Emergency Response System (PERS)	Some plans	A Personal Emergency Response System (PERS) is a medical monitoring system that provides a safety net for people who might need immediate medical assistance when nobody is there to help. Options include in-home and mobile solutions.	VRI: 800-750-8694

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2024 MAPD Benefit Highlights

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Benefit	Availability	Highlight	Contact Info
Meals	Most plans	With this benefit, the member has access to meal programs for post-acute care and/or nutritional shakes.	GA Foods and Mom's Meals: Referral needed – Contact Member Services
In-Home Support	Some plans	With this benefit, members can qualify to receive a range of services to assist with chores depending on plan offerings (12 visits per year).	healthAlign: Referral needed – Contact Member Services
Telehealth	All plans	Telehealth allows healthcare professionals to evaluate, diagnose, and treat members in remote locations using telecommunications technology. This benefit is covered on all Wellcare plans.	Teladoc: 800-835-2362
Nursing Hotline	All plans	This benefit provides telephonic access to nurse assistance 24 hours a day, 7 days a week.	800-581-9952
Routine Chiropractic	Some plans	This benefit provides coverage for members to have access to routine chiropractic services. Original Medicare offers coverage for Medicare- covered chiropractic as well. (12 visits per year)	Local Provider Network
Routine Podiatry	Some plans	Routine podiatry services include routine foot care such as cutting or removing corns or calluses, trimming or cutting nails, and hygienic or other preventive maintenance. (Six visits per year)	Local Provider Network

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Routine Dental

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Benefit Scope	“Bronze” P&D Only No dentures	“Silver” P&D + Minor restorative Includes dentures	“Gold” P&D+ Major Restorative Includes dentures
Allowance Ranges	No max allowance	No preventive max Comprehensive $1,500/$2,000	No preventive max Comprehensive $3,000/$4,000
Covered Service Categories	Preventive Diagnostic +Non-Routine	Preventive Diagnostic Non-Routine +Restorative +Endodontics (non-surgical) +Periodontics (non-surgical) +Other Oral/Maxillofacial (simple and surgical extractions) +Fixed & Removable Prosthodontics	Preventive Diagnostic Restorative Endodontics Periodontics Non-Routine Other Oral/Maxillofacial (simple and surgical extractions) +Fixed & Removable Prosthodontics
Design Options for Member Cost-Share	HMO: $0 for all covered services PPO: $0 INN, 50% OON	INN: $0 cost-share for all; OON: 50% all INN: $0 prev, 20% comp; OON 50% all INN: $0 prev, 40% comp; OON: 70% all	INN: $0 cost-share for all; OON: 50% all INN: $0 prev, 20% comp; OON 50% all INN: $0 prev, 40% comp; OON: 70% all
Limitations and Exclusions	Service and periodicity limits apply	Service and periodicity limits apply	Service and periodicity limits apply
Vendor	DentaQuest: 833-206-6293

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Routine Vision

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Benefit Scope	Vision 100	Vision 200	Vision 300	Vision 400
Allowance Ranges	$100 per year	$200 per year	$300 per year	$400 per year
Covered Service Categories	Glasses (lenses and frames) Glasses (lenses only) Glasses (frames only) Upgrades Contact lenses	Glasses (lenses and frames) Glasses (lenses only) Glasses (frames only) Upgrades Contact lenses	Glasses (lenses and frames) Glasses (lenses only) Glasses (frames only) Upgrades Contact lenses	Glasses (lenses and frames) Glasses (lenses only) Glasses (frames only) Upgrades Contact lenses
Design Options for Cost-Share	HMO: $0 for all covered services PPO: $0 INN, 40% OON	HMO: $0 for all covered services PPO: $0 INN, 40% OON	HMO: $0 for all covered services PPO: $0 INN, 40% OON	HMO: $0 for all covered services PPO: $0 INN, 40% OON
Vendor	Premier: 833-611-7778

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Routine Hearing

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Benefit Scope	Hearing 350	Hearing 500	Hearing 750	Hearing 1000	Hearing 2000
Allowance Ranges	$700 per year $350 per ear, per year	$1,000 per year $500 per ear, per year	$1,500 per year $750 per ear, per year	$2,000 per year $1,000 per ear, per year	$4,000 per year $2,000 per ear, per year
	Routine	Routine	Routine	Routine	Routine
Covered	Routine	Routine	Routine	Routine	Routine
Covered	hearing exam	hearing exam	hearing exam	hearing exam	hearing exam
Service	Fitting/evaluation	Fitting/evaluation	Fitting/evaluation	Fitting/evaluation	Fitting/evaluation
Categories	Hearing aids (all types)	Hearing aids (all types)	Hearing aids (all types)	Hearing aids (all types)	Hearing aids (all types)
Design Options for Cost-Share	HMO: $0 for all covered services PPO: $0 INN, 40% OON	HMO: $0 for all covered services PPO: $0 INN, 40% OON	HMO: $0 for all covered services PPO: $0 INN, 40% OON	HMO: $0 for all covered services PPO: $0 INN, 40% OON	HMO: $0 for all covered services PPO: $0 INN, 40% OON
Vendor	HCS: 866-344-7756

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PY2024 Multi-Benefit Card

Introducing Wellcare Spendables™

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A single card provides an allowance access to multiple benefits

Combines multiple benefits into single card
Pursing strategy for benefit groups based on plan type
D-SNP plans include a single purse for OTC, Grocery, Gas Pay-at-Pump, and Utility and Rent Assistance, and may include DVH cost-shares in that purse depending on the plan
Non-D-SNP plans include a single purse for OTC and, depending on the plan, DVH cost-shares will be included in that purse. If the plan has SSBCI Utility, it will be a separate purse on the card.
Simple and convenient to use
Benefits loaded each period
Amounts will vary by plan
Allows member to use the benefit as they choose to meet their needs
Solutran is the national partner to administer the Wellcare Spendables™ experience
Currently a trusted partner for six Medicare competitors
Retailer Direct Network includes more than 55,000 stores nationwide

Benefits Covered	Retailer Direct via Debit Card In-Store or Online* Any Item w/Approved SKU/ Category Code Retailer Network	Mail-Order** via Phone Call or Portal List/“Catalog” of Approved Items and Products Single Fulfillment Vendor (TBD)
DVH Cost-Share Assistance if applicable (Dental, Vision, and Hearing Cost-Share)	Network = Approved MCC Codes	N/A
OTC (Over-the-Counter)	Retailer Network	Yes, Limited
Healthy Food (D-SNP Only)	Retailer Network	Yes, Limited, Shelf Stable
Utility/Rent Assistance (D-SNP Only)	Network = Approved MCC Codes	N/A
Gas (D-SNP Only) (Pay-at-Pump)	Network = MCC Codes	Pay at Gas Pump
SSBCI Utility (Non-SNP)	Network = Approved MCC Codes	N/A
	*Online shipping and delivery fees will use allowance funds.	**Mail order will require minimum amount for free shipping.

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Wellcare Spendables™

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Benefit Designs

	Benefit Package Design	Periodicity	Purse Design
D-SNP Plans – Scenario 2	VBID Benefits Gas Pay-at-Pump Healthy food Utilities assistance Rent Assistance OTC Dental, Vision, Hearing	Monthly, rolling	Single purse Managed as combined allowance VBID and OTC benefits on all D-SNPs Plans may elect to include DVH
Non-SNP – Scenario 1	OTC Dental, Vision, Hearing	Monthly, rolling	Single purse Managed as combined allowance
Non-SNP – Scenario 2	OTC Only	Quarterly, non-rolling	Single purse Single allowance

Beans and legumes
Canned fruits and vegetables
Dairy products
Fresh fruit and vegetables
Fresh salad kits
Frozen produce and meals
Healthy grains - bread, cereals, pastas, etc.
Meat and seafood
Nutritional shakes and bars
Pantry staples - flour, sugar, spices, etc.
Soups
Water/vitamin water

Category Level

Healthy food items are managed at a category level. Categories allow members to purchase brand name or generic items, and we have the ability to limit approved categories to ensure members purchase approved items.

Healthy Foods OTC

Allergy and sinus
Cold and flu
Dental and oral health
Diabetes care
Digestive health
Eye and ear care
First aid
Foot care
Home health care and daily living
Incontinence products
Pain relief
Skin care
Sleep aids
Smoking cessation products
Supports, braces, and wraps

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Wellcare Spendables™

Store Location Finder

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The link below will allow agents to type in a ZIP code to find the nearest participating S3 retail stores available for the 2024 Wellcare Spendables™ program. As new stores are added to the network, the store finder is updated to include those locations.

healthybenefitsplus.com/xyzdemo/stores/storefinder

Step 1: Enter ZIP Code

Step 2: See Participating Stores

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Part B Diabetic Testing Supplies Strategy

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Preferred manufacturers:

Traditional diabetic testing supplies: OneTouch covered with quantity limit (one meter per 365 days; 100 test strips per 25 days)
Continuous blood glucose monitoring: Dexcom or FreeStyle Libre with prior authorization

Non-preferred manufacturers:

Covered with approved prior authorization at the preferred manufacturer copay

The vendor for the benefit is:

2024 PERS Benefit

PY2024	PERS Devices	Access to Benefit
VRI will continue as national vendor. Markets with members who still utilize a Best Buy-owned device have the option to transition members to VRI devices.	23 device options In-home analog and in-home cellular devices Mobile units that operate cellularly both in and outside of the home Remote vital sign monitoring Medication monitoring Fall prevention 24/7 monitoring	Members are able to place their order online; self- enrollment benefit Members on plans with the benefit can go to www.wellcarepers.com and enroll Call 800-750-8694 to speak with a representative Monday – Friday 8 a.m. to 8 p.m. EST.

2024 NEMT Benefits

PY2024
Updated list of approved locations Daily limit of up to four one-way trips per day Vendor: MTM: 844-524-1401
Transportation Modes
Ambulatory including (taxi, ride-share services) Wheelchair van Stretcher van Public transportation Gas and mileage reimbursement

Packages Available
36 one-way trips per year	75 miles
60 one-way trips per year	75 miles
Unlimited one-way trips per year	75 miles

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2024 ASH (Silver & Fit) Benefits

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Silver & Fit members have access to:

Workout plans: Online support, including orientation, suggested workouts, and guidance
Digital Fitness choices and home fitness tools: including 8,000+ digital workout videos
Home Fitness Kits: Members may select one home fitness kit per benefit year

10 different kits to select from
Member may obtain kit and attend physical facilities
Fitness tracker device

Live one-on-one healthy aging coaching: including nutrition, healthy eating, coaching, and getting started with home fitness kits
Fitness Membership Choices: standard fitness network of 14,800+ locations

NEW! Well-Being Club	Expanding! Digital Fitness	Expanded! Fitness Centers
Virtual well-being club for all members Personalized to meet each member where they are in their wellness journey Provides an integrated approach and effective activities, virtual classes, on-demand video workouts, articles, and audio resources Evidence-based expertly curated experiences for members	Digital library has expanded to 8,000+ workout videos and expected to grow Members may choose, create, and curate their own online fitness experience based on their preferences Workout plans enable customizations for every participant’s fitness journey	Offering more than 14,800 fitness centers network Members who are offered multi- fitness center access will continue to enjoy current privileges such as changing fitness centers any time Members offered single fitness center access are able to change centers once per month Network includes YMCAs

Silver & Fit: A Three-Pronged Strategy for Healthy Aging & Exercise
Digital Fitness Choices with Home Fitness Tools	Well-Being Choices	Fitness Membership Choices
Workout plans with digital exercises and guidance to get started Home fitness kits, Fitbit, Garmin, yoga, strength kits, and more 8,000+ on-demand workout videos including 2,500+ videos designed for older adults and baby boomers 250+ trackers and apps	Live Healthy Aging Coaching: exercise, nutrition, social isolation, and more Well-Being Club: personalized healthy habit resources, community building, live- streamed classes and more Rewards 120,000+ social clubs Additional fall prevention services and products: home assessments and OTC program for fall prevention tools	Total fitness membership choices: 19,500+ Standard fitness network choices (18,000+) include fitness centers, YMCAs, gender-specific, instructor-based, senior centers, sessions at fitness studios, yoga, Pilates, and more Member price: $0 (or small member fee determined by health plan)

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2024 Meals Benefits

Mom’s Meals

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Packages Available
Post-Acute Meals 3 meals per day for 14 days Total 42 meals	$0 copay Home delivered meals or shakes immediately following an inpatient hospital stay

PY2024

Shakes and tailored meals will continue to be offered
Chronic conditions list:

Congestive heart failure
COPD
AIDS
Asthma

Coronary Artery Disease
Diabetes
Hypertension

Benefit Details

Provides meals that are tailored to support nine different health conditions. Menu options include general wellness, lower sodium, heart-friendly, diabetic-friendly, renal-friendly, gluten-free, vegetarian, cancer support, and pureed.
Allows members to choose every meal from every order for longer programs and to customize their individual preferences for shorter programs.
Members can request to speak with a registered dietician while on the phone with Customer Care team.
Shake options include Boost Plus, Boost High Protein, Boost Soothe, and Boost Glucose Control.
Mom’s Meals does not have any limitations operating in certain geographical areas. Mom’s Meals can reach any address in any market and geography in the United States.

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2024 Meals Benefits

GA Foods

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PY2024

Offers a variety of prepared, frozen meals and shakes
Chronic conditions list:

Congestive heart failure
COPD
AIDS
Asthma

Coronary Artery Disease
Diabetes
Hypertension

Benefit Details

Meals delivered in 48 hours
Ability to choose from full line of general wellness meals, medically tailored meals, specialty, and cultural meals
GA Foods provides full line of oral nutrition supplements of Ensure Plus, Glucerna, Supplena, Juven, and Nepro.
Vendor utilizes third-party courier delivery for rural areas.

Packages Available
Post-Acute Meals 3 meals per day for 14 days Total 42 meals per occurrence	$0 copay Home delivered meals or shakes immediately following an inpatient hospital stay Occurrences are unlimited per year
Shakes Up to 3 cases per month	Member has the option to receive shakes instead of meals as medically appropriate Shakes delivered in cases Shake counts as one meal

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2024 In-Home Support

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PY2024
Vendor will continue to be healthAlign. This is not the SSBCI chores benefit. Services will be managed to the requirements of each program authorization as approved by Plan Case Management.
Packages Available
Service	Visits	Benefit
Chore Services	12 visits per year (number of visits vary by plan) Visits are available in two-hour increments	Making member’s bed • Serving meals to Cleaning bathroom member Cleaning kitchen • Laundering of Cleaning main living area member’s clothes Preparing meals

2024 Chiropractic

PY2024
Chiropractic available as standalone benefit Services will be administered by a local provider
Packages Available
Service	Visits	Benefits
Chiropractic	12 visits	Supplemental coverage for evaluation and management, X-ray examination, chiropractic manipulation therapy, modalities and therapeutic procedures, physical rehabilitation for musculoskeletal conditions of the spine and extremities

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2024 Podiatry Benefits

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PY2024
Supplemental Podiatry is not administered by a vendor. It is administered through local provider network.
Packages Available
Visits	Benefits
6 supplemental visits	Supplemental Coverage: Routine care Cutting or removing corns and calluses Trimming, cutting, or clipping nails Hygienic or other preventive maintenance such as cleaning and soaking feet Depending on exam results, provider may include additional treatment for foot ulcers and toenail management.

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Value-Based Insurance Design

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PY2024 VBID D-SNP Benefit Changes

The Value-Based Insurance Design (VBID) Model is a program that allows participating Medicare Advantage insurers to reduce cost-sharing or provide additional supplemental benefits for targeted enrollees based on chronic condition or socioeconomic status. For Plan Year 2024, all D-SNP plans will offer a VBID model targeting the low-income (LIS) population. The model intends to address socioeconomic barriers to health and wellness.

One Purse	Healthy Food (VBID)	Allowance-based benefit; rolling month-to-month Allowance will be available via Wellcare Spendables™ card Members are not required to take action to receive the benefit
	Utility & Rent Assistance (VBID)	Allowance-based benefit Allowance will be available via Wellcare Spendables™ card Inclusion of rent assistance
	Over-the-Counter (OTC)	Part of Wellcare Spendables™ card Purchase methods will include in-store, mobile app, phone, and web orders Solutran offers significantly expanded in-store footprint with multiple retailers Catalog will be available and sent to all members
	Gas Pay-at-Pump (VBID)	Allowance-based benefit Allowance will be available via Wellcare Spendables™ card Allowance issued monthly; rolling throughout the year Members are only allowed to use the debit card at the pump
	Rx $0 Cost-Sharing – All Tiers (VBID)	No change to benefit Administered at point of purchase at any network pharmacy

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Pharmacy

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2024 Part D Product Design for MAPD

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Part D Program Highlights

All plans offer $0 copay for all vaccines recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) for use in adults.
All plans have a $35 cap on cost-sharing per one-month supply of covered insulins for all coverage phases.
Members will pay $0 for brand and generic medications once they reach Catastrophic coverage for the remainder of the year (once total member out-of-pocket costs reach $8,000).
Maximum day supply of prescriptions increased from 90 to 100 days at the same copay.
Excluded drug coverage of generic erectile dysfunction drugs on Tier 1 is offered on enhanced plans and is being expanded to include popular vitamins: Vitamin D2, Vitamin B12, and Folic Acid.

Competitive Benefits

All TMA plans have a $0 or tier-specific deductible.¹
All D-SNP plans will have no deductible and $0 copays through all benefit stages.
All TMA plans feature a $0 copay and $0 deductible for Tier 6 which includes most Stars adherence medications.²
TMA plans have $0 copay and $0 deductible for preferred generics on Tier 1 at preferred pharmacies.
Select TMA plans have full and/or partial gap coverage on Tiers 1, 2, and/or 6.

Tier-specific deductible means a deductible on only Tiers 2-5, 3-5, or 4-5;
Stars adherence medications include specific classes of drugs used to treat diabetes, high blood pressure, and high cholesterol

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2024 Pharmacy Benefit Manager

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Effective Jan. 1, 2024, Express Scripts Pharmacy® will be managing our pharmacy benefits administration. This will impact all Part D plans, including MAPD and PDP.

All members will receive a new 2024 ID card prior to Jan. 1, 2024, with updated pharmacy processing information.
It is very important for members to bring their new card to the pharmacy to receive their prescriptions, as claims will not process without the new card.
Members will receive several communications about the importance of using their new card throughout AEP:

Letter/Flyer (ANOC, etc.)
ID Card Letter
Call Campaigns

Preferred Pharmacy Network

Walgreens and CVS plus grocers remain within the preferred pharmacy network for 2024.

Mail Order

Effective Jan. 1, 2024, Express Scripts Pharmacy® will replace CVS Caremark® as our preferred mail order provider.

CVS Caremark Mail Order will be out-of-network in 2024. If members decide to continue to use mail order, they must switch to Express Scripts effective Jan. 1, 2024.
For existing mail order users, open prescription refills will be transferred to Express Scripts.
For any new mail order prescriptions, members will be able to set up a member profile with Express Scripts beginning Dec. 1, 2023, but will only be able to initiate an order beginning Jan. 1, 2024.
Communications will be sent to members with further information and actions needed to access this benefit.
Like CVS Caremark , Express Scripts will be managing all mail order operations, including providing a call center to support member inquiries.
Preferred mail order discounts are available:

Tiers 1, 2, and 6 = $0 copay for 100-day supply
Tier 3 = 2 x preferred retail copay for 100-day supply

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Prescription Drug Plan

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PDP Overview

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3 unique plans per region

4.4M members

#2 standalone individual PDP

3 Star quality rating

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2024 Low Income Subsidy Chart

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CMS Copay Category	Your Eligibility	Your Premium Subsidy	Deductible you pay (if applicable)	Your Standard LIS Cost-Share
				Deductible Stage		Catastrophic Stage $8,000
				Initial Coverage Stage $5,030
				Coverage Gap Stage
				Generic	Brand	Generic	Brand
3	Full Subsidy (FBDE) Full Benefit Dual Eligibles (FBDE) Individuals Institutionalized Beneficiaries Beneficiaries receiving home and community-based services	100%¹	$0	$0	$0	$0
2	Full Subsidy (QMB+, FBDE) Full Benefit Dual Eligibles (FBDE) Individuals Non-Institutionalized Beneficiaries Up to or at 100% FPL	100%¹	$0	$1.55 ²	$4.60 ²	$0
1	Full Subsidy (SLMB+, FBDE) Full Benefit Dual Eligibles (FBDE) Individuals Non-Institutionalized Beneficiaries Between 100% and 150% of FPL OR Full Subsidy (QMB, SLMB, QI) Non-FBDE Individuals QMB / SLMB / QI, SSI Income at or below 150% of FPL and resources <= $17,010 (individuals) or <= $33,950 (couples)	100%¹	$0	$4.50 ²	$11.20 ²	$0
4	Partial Subsidy (QDWI) Income below 150% FPL with resources TBD $17,010 (individuals) or <= $33,950 (couples)	100%¹	$0	$4.50 ²	$11.20 ²	$0
0	No Subsidy Assistance	0%	$545 (unless your plan has a lower deductible)	Varies by region (Deductible and Initial Coverage Stages) 25% coinsurance (coverage gap stage)	Varies by region (Deductible and Initial Coverage Stages) 25% coinsurance (coverage gap stage)	$0	$0

If you qualify for 100% subsidy,you may still pay a premium depending on the plan you select.
During the Initial Coverage Stage: Any time the actual cost of drugs or the plan's non-subsidized copay is less than the subsidized co-pay, the member pays the lesser amount. Subsidized members pay ONE co-pay, regardless of the number of days (1-month or 3-month supply) they are getting filled.

Resource limits include $1,500 for burial expenses

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2023 vs. 2024 Part D Parameters

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2024 Wellcare PDP Product Changes

Key Design Highlights

102 plans nationwide.
All plans have a $0 Tier 1 preferred benefit.
Value Script plan has one of the lowest premiums in the country!

Plan premiums are less than $1 on average
14 regions feature a $0 premium
All PDP plans are fully commissionable

All PDP plans will have a consistent preferred and standard network design.
Due to Inflation Reduction Act (IRA), all members will now pay $0 when they reach the Catastrophic phase.

Formulary Highlights

New Tier 6 formulary will be offered on the Classic plan containing non-insulin diabetic drugs.

Copay will be $0 on Tier 6 for a 30-day supply for Classic (after deductible).
Value Script and Value Plus offer Tier 6 for no more than an $11 copay (after deductible, if applicable).

Standard Benefit Parameter Changes
	2023	2024
Deductible	$505	$545
Initial Coverage Limit (ICL)	$4,660	$5,030
Out-of-Pocket Threshold (TrOOP)	$7,400	$8,000
Coverage Gap Coinsurance*	Generics 25% Brands 25%	Generics 25% Brands 25%
Catastrophic Coverage	Greater of 5% or Generics $4.15 Brands $10.35	$0
Other LIS Parameter Changes
Partial Deductible	$104	$0
Generic Drug Copay (depending on LIS level)	$0/$1.45/$4.15/15%	$0/$1.55/$4.50
Brand Drug Copay (depending on LIS level)	$0/$4.30/$10.35/15%	$0/$4.60/$11.20

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2024 PDP Portfolio At A Glance

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	Duals		Low Premium		Richest Coverage
Plan Name	Classic		Value Script		Rx Value Plus
Plan Number	S4802074000		S4802154000		S4802223000
Premium	$35.70		$0.50		$85.20
Deductible	$545 (applies to all tiers)		$545 (applies to Tiers 3, 4, 5, and 6)*		$0
Retail Type	Pref Retail	Std Retail	Pref Retail	Std Retail	Pref Retail	Std Retail
	T1: $0	T1: $3	T1: $0	T1: $5	T1: $0	T1: $5
	T2: $5	T2: $8	T2: $5	T2: $10	T2: $4	T2: $10
Initial Coverage Stage	T3: 21% T4: 40%	T3: 21% T4: 41%	T3: 25% T4: 50%	T3: 25% T4: 50%	T3: $47 T4: 50%	T3: $47 T4: 50%
	T5: 25%	T5: 25%	T5: 25%	T5: 25%	T5: 33%	T5: 33%
	T6: $0	T6: $0	T6: $11	T6: $11	T6: $11	T6: $11
Initial Coverage Limit	Up to $5,030 in Rx costs		Up to $5,030 in Rx costs		Up to $5,030 in Rx costs
Network (Preferred Pharmacies)	CVS, Walgreens, and select grocers		CVS, Walgreens, and select grocers		CVS, Walgreens, and select grocers
Service Area	Plans available statewide		Plans available statewide		Plans available statewide

Agent use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination.

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Broker Experience Enhancements

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2024 Certification Requirements

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Completing the Wellcare Annual Certification Training (ACT) comes with many benefits:

AHIP integration when accessed through the Centene Learning Center:

Discounted AHIP pricing ($125 vs $175)
Real-time AHIP to ACT training availability
Hierarchal training path (ensures all CMS required training elements

met): 2024 AHIP 🡺 2024 ACT Journey 🡺 2024 ACT Product 🡺 2024 ACT Exam

Certifies you to market/sell all 2023 and 2024* Wellcare Medicare MAPD and PDP product offerings.
Access to CustomPoint (sales material ordering)

Broker Portal: Centene Workbench

wellcare.cmpsystems.com

The Centene Workbench broker portal is a best-in-class tool to help our partners succeed. Key features include but are not limited to:

Ability to manage onboarding invitations and tracking (upline only feature)
Improved support tickets experience and self-service workflows
Enhanced dashboard reporting, such as new application status, Medicare book of business, and new enrollments
Ability for brokers to manage their demographic information, licensing, and downline brokers (where applicable) through self-service workflows

New Centene Workbench features:

Upload Application: Allows brokers to upload paper applications and track them directly within their portal
ID Card Feature: Allows brokers to obtain member ID cards within their book of business
Deeming Period Feature: Allows brokers to identify members within the deeming period

Note: Complete Wellcare ACT and Contract Recertification tasks in Centene Workbench by Sept. 30 annually to ensure you are ready to sell the next year plan effective enrollments by Oct. 1.

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Network Improvements

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We are making it easier to do business with us!

New in 2024! For Wellcare plans, members will enjoy access to the most in-network providers across 37 states!
We have modified our directory structure so members can find and access care across state lines.
This effort represents our first steps toward a national network with full reciprocity. We intend to expand to all brands and products in the future.

Note: Some providers may choose to opt out. Limited to Wellcare and not available across all legacy Centene plans. Legacy Centene plans specifically refers to Wellcare By Allwell, Wellcare By Health Net, and Wellcare By Fidelis.

Ascend

Ascend is the preferred quote and enrollment platform for all Wellcare plans including legacy Allwell, Health Net, Superior, and Fidelis plans. Ascend allows for side-by-side comparisons of key features and includes the following functionality:

Quick Quote feature allows quotes and PURLs to be emailed to beneficiaries for agent-credited applications.
Agent Portal is available for tracking enrollment status, quote, Send for Signature, and VBE submissions within Ascend.

NEW this year: saved applications will be available for 14 days; the previous limit was seven days.

Provider and Pharmacy network comparison feature is available across all brands with accepted plans.

NEW this year: the ability to select and compare multiple providers and pharmacies, as well as easily see provider network and PCP status across all plans, with reminders if a PCP is not selected on the application. Provider search feature is also improved with the ability to search by IPA, medical group, address, and phone number.

Text, email, and face-to-face SOA options are available. NEW this year: SOA options on Ascend AQE web.
Salesforce lead management integration
Telephonic and Zoom enrollment options for field agents (RATE)
Send for Signature feature allows for beneficiary signature via email.
Eligibility, Medicaid, and Extra Help Checks will be more accessible; now moved to earlier in the quoting flow.
NEW this year: 2024 enrollment applications will be available on Oct. 1 for ICEP enrollments.

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Health Risk Assessments and Value-Based Enrollment

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Wellcare offers brokers an administrative payment for Health Risk Assessments (HRAs) completed at the point of sale.
HRAs can be captured directly in Ascend and Sunfire after the enrollment is submitted using their integrated tools or can be submitted using the standalone VBE link.

2023 standalone link: https://wellcare.isf.io/2023/vbe/addmember
2024 standalone link: https://wellcare.isf.io/2024/vbe/addmember
If using the standalone tool, please review the 2024 Ascend Integrated and Standalone VBE Guide for Brokers

2024 administrative payments will remain the same. Remember that in order to receive payment or credit, you must fully complete the HRA by clicking submit, which will be followed by an HRA confirmation number.

$225 administrative payment for eligible D-SNP/C-SNP enrollments
$75 administrative payment for eligible MA/MAPD enrollments

Note: The information above does not apply to Teledigital partners. The admin payments may be subject to change. Refer to Wellcare Broker Communications for the latest information.

Medicaid, LIS, and Medicare Eligibility Checks

As a reminder, when enrolling low-income and Medicaid-eligible beneficiary, you should always perform an eligibility check to ensure accurate quoting.
Ascend and Sunfire offer integrated Medicaid, LIS, and Medicare eligibility checks within their systems. Both platforms also confirm eligible plans based on MSP/Medicaid levels.

System features also include Part A, B, and D start dates, last used SEP date, current plan H_PBP, and current plan enrollment date.

Please use this Ascend user guide for more information on how to check eligibility: https://wellcare.isf.io/2024.
The SPOP call center is also available to assist with eligibility checks and make plan recommendations based on MSP/Medicaid levels.

866-211-0544
Monday – Friday, 8 a.m. – 8 p.m. EST
Saturday – Sunday, 8 a.m. – 5 p.m. EST

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Salesforce

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Created the following:

Quick Quote for dispositioned leads with 15-day default
New lead population notes field
Enrollment information section to eliminate need for copying and pasting into notes field when filling out lead templates

Requested creation of Send for Signature disposition when leads are sent from Ascend
Access requests processed within three business days
Enhanced auto assignment reporting
Auto assignment growth has led to less unassigned leads
Reorganization of broker details page: more user-friendly with less scrolling

2024 Sales Materials

Brokers can order sales materials via the CustomPoint materials portal. This includes all required materials for a compliant sales appointment.
CustomPoint can be accessed via the broker single sign-on portal and offers the capability to select state and product-specific materials for both Medicare and PDP, specify shipping addresses for each submitted order, and obtain real-time shipment tracking information and order status.
2024 materials will available as downloadable PDF files by Oct. 4.

Sales Material Ordering and Distribution

2024 sales materials were available for order beginning Sept. 27 and available as downloadable PDF files on Oct. 4. Please note order and delivery timelines:

Shipping Event	Ordering Begins	Ordering Ends	Estimated In-Hand Date
Wave 1	Pre-orders for select brokers in July	July 31 EOD	Sept. 27
Wave 2	Brokers can pre-order Aug. 14	Aug. 20 EOD	Sept. 27
Ongoing	Sept. 27	N/A	5-7 business days

Note: You must be certified to sell 2024 Wellcare products to order.

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Wellcare First Look

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Wellcare Medicare Advantage products
Key selling features for PUSH products
Wellcare PDP products
Local support
Digital Resource Center

Wellcare First Looks provide a quick reference of the 2024 Medicare product portfolio. The information provided is divided by market. Brokers and agents can find marquee benefits for plans that are available for beneficiaries during the AEP.

The First Look Microsite provides information on: 2024 highlights include:

Product expansion
Geographic expansion
Product overview of PDP
Network highlights
MAPD key design highlights
Enhancements to ancillary benefits

wellcarefirstlook.com

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Broker Communications

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Be on the lookout for important email communications throughout the 2024 AEP season.

Communication Type	Communication Topics
Broker Update	Contracting and certification reminders Special Election Period announcements (e.g., FEMA, state/local declarations) Commission rates, schedules, and announcements CustomPoint material ordering schedule and reminders
Wellcare Insider/ AEP Weekly News	Important updates and reminders Other updates critical to your business
Product Pointers	New and/or key supplemental benefit updates Supplemental video resources
The Ascend Advantage	Ascend reminders, pointers, and helpful tips

Broker Support Resources

Support	Purpose	Contact Information
Broker Support	Assistance with contracting, certification, commissions, onboarding, etc.	866-822-1339 Mon – Fri: 8 a.m. – 8 p.m. EST
Request for Information (RFI) - Legacy Plans*	Assistance with Request for Information (RFI) on Legacy plans*	844-202-6811 Mon – Fri: 12 p.m. – 8 p.m. EST
Request for Information (RFI) - Wellcare	Assistance with resolving applications in Pending status	866-822-1339 Mon – Fri: 8 a.m. – 8 p.m. EST
Special Populations (SPOP) Medicaid Eligibility	Eligibility support for Medicare and Medicaid	866-211-0544 Mon – Fri: 8 a.m. – 8 p.m. EST Sat – Sun: 8 a.m. – 5 p.m. EST
Telephonic Scope of Appointment (SOA)	Document SOA via phone	877-780-3920 (MAPD) 877-297-3625 (PDP)
Paper Application Submission	Submit paper enrollment applications via FAX	FAX numbers can be found at: www.wellcare.com/broker- resources/broker-resources

*Legacy plans include: Allwell, Health Net

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Member Experience Enhancements

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Member Journeys

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The member onboarding journey resources linked below provide detailed roadmaps of critical milestones for a member’s onboarding process, including all communications sent to a member to help them become fully educated about and prepared for their new plan. Select the appropriate link to learn more about the steps involved in each type of onboarding journey.

New Member Onboarding Journey (AEP)
New Member Onboarding Journey (Non-AEP)
Renewing Member Journey (AEP)
New Member Onboarding Journey (AEP & Non-AEP) Broker Video

New Member Experience Updates

NEW paperless feature on Wellcare member portal is available. Members can now opt in to receiving communications electronically via their member portal. This feature is for Legacy Wellcare only; Allwell, Healthnet, and Fidelis will be phased in next year.
Text and email opt-in for plan communications is now available on all enrollment applications.
NEW Enrollment Application tracker will be available for beneficiaries and brokers to track application status. The standalone website will not require a login and will require only a few key pieces of information.
All members with benefit changes (positive and negative) will receive an additional communication outlining changes, vendor information, and important tips on how to access their benefits in 2024. These letters will be mailed by the end of October.
All members will receive new ID cards in 2024. New members will be prioritized and will receive ID cards 7-10 business days after enrollment confirmation. Existing member ID cards will be mailed starting the second week of November and continue through mid-December.

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New for 2024: Going Paperless

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Wellcare plans are offering members a paperless experience via the Wellcare Member Portal beginning in 2024. Beginning in January, members on Wellcare plans will be able to access paperless communications via their Wellcare Member portal. This new feature ensures speed, convenience, and 24/7 access to documents, all in place.

This feature is available only for legacy Wellcare plans, MAPD, MA, PPO, and PDP plans. Wellcare By Allwell, Wellcare By Healthnet, and Wellcare By Fidelis will not have paperless options until 2025.
Opt-ins can be achieved through enrollment forms, Member Services, and the member portal. Members can opt out at any time by calling Member Services or through the member portal.
Members who opt in will receive an email confirming their opt-in. Each time a new document is available in the portal, an email is triggered directing them to their portal to view the document.
Documents currently available for opt-in are EOBs; however, we expect many additional documents to become opt-in eligible throughout 2024.
Members will not be able to choose which documents they opt in to receive. Once new documents are available, they will automatically be sent to the portal for viewing.
Once a member opts in, they will no longer receive paper communications for documents that have been sent to the portal.

Member ID Cards

Agents may download plan ID cards for members in their book of business using Centene Workbench.

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Quick Reference

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Quick Reference

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Plan Name	Contract Number	PCP Copay	SPC Copay	Inpatient Acute	Wellcare Spendables™^*	RX Deductible/ Tiers	T1 (Pref)	T6 (Pref)
Wellcare No Premium Open (PPO)	H0074001000	$0	$40	$295 copay per day for days 1-6	$22/mo	$250 on T 3-5	$0	$0
Wellcare Dual Access Open (PPO D-SNP)	H0074004000	$0	$0	$0 copay up to 90 days per admission	$100/mo	$0	$0	$0
Wellcare Low Premium (HMO-POS)	H1416026000	$0	$35	$300 copay per day for days 1-5	$76/qtr	$0	$0	$0
Wellcare Dual Access (HMO D-SNP)	H1416034000	$0	$0	$0 copay up to 90 days per admission	$180/mo	$0	$0	$0
Wellcare Dual Liberty (HMO D-SNP)	H1416044000	$0	$0	$0 copay up to 90 days per admission	$210/mo	$0	$0	$0
Wellcare Patriot Giveback (HMO-POS)	H1416060000	$0	$35	$350 copay per day for days 1-5	$82/qtr	N/A	$0	$0
Wellcare Giveback (HMO)	H1416065000	$0	$45	$475 copay per day for days 1-4	$40/qtr	$545 on T 3-5	$0	$0
Wellcare Assist (HMO)	H1416068000	$0	$30	$325 copay per day for days 1-5	$35/mo	$440 on T 2-5	$0	$0
Wellcare No Premium (HMO)	H1416070000	$0	$35	$300 copay per day for days 1-6	$29/mo	$275 on T 4-5	$0	$0
Wellcare No Premium (HMO)	H1416071000	$0	$35	$300 copay per day for days 1-6	$27/mo	$375 on T 3-5	$0	$0
Wellcare No Premium (HMO)	H1416072000	$0	$35	$300 copay per day for days 1-6	$29/mo	$275 on T 4-5	$0	$0
Wellcare All Dual Assure (HMO D-SNP)	H1416081000	$0	$0 - $30	$0 - $300 copay per day for days 1-5	$40/mo	$0	$0	$0

^*For more Wellcare Spendables™ package information, please see the PY2024 Products section above and the Wellcare Spendables™ section in Supplemental Benefits.

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Ancillary Benefits Vendor Contact

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Benefit	Vendor	Vendor Contact Info
Transportation	MTM	844-524-1401 https://memberportal.net
Over-the-Counter	Solutran	855-744-8550 Member portal
In-Home Support Services	healthAlign	Referral needed – contact Member Services*
Meals	GA Foods Mom’s Meals	Referral needed – contact Member Services*
Fitness	ASH	877-427-4744 www.SilverandFit.com
Personal Emergency Response System (PERS)	VRI	800-750-8694 https://wellcarepers.com
Dental	DentaQuest	833-206-6293
Vision	Premier	833-611-7778 www.premiereyecare.net
Hearing	HCS	866-344-7756 www.hearingcaresolutions.com
Telehealth	Teladoc	800-835-2362

*Contact Case Management for Meals and In-Home Support Services - 866-635-7045

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Appendix

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Plan Action

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Definitions

Action: Action of the plan moving from prior year to upcoming year
Segmented: Indicator for a plan that is segmenting the counties in the services area: the last 3 digits of the H contract number
Renewal Plan with Service Area Expansion (SAE): Indicator for a continuing plan with a service area expansion
Renewal Plan with Service Area Reduction (SAR): Indicator for a continuing plan with a service area reduction
Consolidated Renewal Plan (Automatic Roll to an Existing Plan or New Plan): Indicator for a plan that is crosswalking into another plan (either existing or new)
Contract Consolidation (Automatic Roll to an Existing Contract or New Contract): Indicator for an H contract that is consolidating into another H contract (HXXXX)
Terminating Plan: Indicator for a plan that is no longer being offered for the upcoming year

2023 Plan Name	2023 Contract Number	2024 Plan Name	2024 Contract Number	Plan Action
Wellcare Premium Hybrid Open (PPO)	H0074002000	N/A	N/A	Terminate
Wellcare Community Assist (PPO)	H0074003000	N/A	N/A	Terminate
Wellcare No Premium Medicare (HMO)	H9811001000	N/A	N/A	Terminate
Wellcare Dual Access Medicare (HMO D-SNP)	H9811006000	N/A	N/A	Terminate
Wellcare Giveback Boost (HMO)	H9811008000	N/A	N/A	Terminate
Wellcare Assist Complement (HMO)	H9811009000	N/A	N/A	Terminate

CMS Final Rule

It is important to be familiar with the new CMS Sales and Marketing regulations for 2024. For more information, please review the following documents on the AEP Readiness Resources site:

Medicare Marketing & Sales Compliance FAQ
New CMS Marketing & Sales Rules FAQ

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CY2024 Formulary Changes – MAPD

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Formulary Strategy: Improve or maintain quality and competitiveness while minimizing member disruption.

Key Takeaways

Approximately the same percent of members are impacted by positive changes at 3.1% as negative change at 3.5% (below the industry average 5-8%).

Positive Impacts

Primarily driven by tier decreases for competitiveness including generic tier improvements on 6T Enhanced MAPD formulary. Additional tier improvements made benefiting all enhanced plans: Synthroid and esomeprazole.
Added drugs with rebates: Mounjaro, Stelara, Actemra

Negative Impacts

Primarily driven by removals due to industry-wide rebate and regulatory changes: Lantus, Levemir, Victoza, Byetta, and Flovent
Competitive tier increases on Enhanced Plus formulary: Budesonide, sevelamer, Simbrinza, levalbuterol HFA
Formulary edits such as quantity limit additions to support safety and manage specialty utilization

Notes: Utilization dates Jan. 1 – Jan. 5, 2023; Formulary changes are subject to change until CMS approves formularies in July 2023

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Formulary Improvements

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Improved generic tier placements on enhanced plan formulary increasing competitiveness from 74% to 86% aligned and favorable.

Enhanced coverage of popular vitamins on Tier 1, such as folic acid, vitamin D, and injectable vitamin B12.

Expected to improve access and affordability for more than 32,000 members.

More than 200 drugs moved to lower tier on enhanced plan formulary resulting in lower cost-share for 3% of MAPD members (approx. 37,000). Most common examples:

Albuterol HFA (T2)
Ondansetron (T2)
Synthroid (T3)
Memantine (T2)
Estradiol (T2)
Bupropion ER (T2)

Bumetanide (T2)
Ipratropium Br (T2)
Levocetirizine (T2)
Testosterone Cyp (T2)
Esomeprazole (T2)
Solifenacin (T2)

Formularies are subject to change until CMS approves formularies

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CY24 Formulary Change – PDP

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Formulary Strategy: Improve or maintain quality and competitiveness while minimizing member disruption.

Key Takeaways

More positive changes (12.2%) than negative changes (6.5%)

Positive Impacts

Primarily driven by tier decreases for competitiveness
Tier improvements on 6T Enhanced PDP: rosuvastatin, clopidogrel, Eliquis, glimepiride
Tier improvements with $0 Tier 6 on 6T Basic PDP: SGLT2s and DPP4s including Jardiance, Januvia, and Farxiga
Added drugs with rebates: Mounjaro, Stelara, Actemra

Negative Impacts

Primarily driven by removals due to industry-wide rebate and regulatory changes: Novolog, Lantus, Levemir, Victoza, Byetta, and Flovent
Tier increases on Basic PDP formulary for product differentiation: clopidogrel, brimonidine, amitriptyline
Formulary edits including quantity limits to support safety and manage specialty utilization

Notes: Utilization dates Jan. 1 – June 5, 2023; Formulary changes are subject to change until CMS approves formularies in August 2023

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For further product information, visit the Wellcare First Look and AEP Readiness Resources sites.

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