Kansas Plan Materials and Forms


This booklet gives you a summary of costs and coverage in your plan. 

Please select the document for your plan and county:

For HMO Members:

Plan Name CMS#  County Summary of Benefits
Wellcare Complete No Premium (HMO) H5398-002 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
Wellcare Complete - Giveback (HMO) H5398- 004 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

For PPO Members:

Plan Name CMS#  County Summary of Benefits
Wellcare Complete No Premium Open (PPO) H6830-001 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:

For HMO Members

Plan Name CMS #  County Evidence of Coverage (EOC)
Wellcare Complete No Premium (HMO) H5398-002 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
  • Dental Benefit Details - English (PDF) - coming soon
Wellcare Complete - Giveback (HMO) H5398- 004 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
  • Dental Benefit Details - English (PDF) - coming soon

 

For PPO Members: 

Plan Name CMS# County Evidence of Coverage (EOC)
Wellcare Complete No Premium Open (PPO) H6830-001 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
  • Evidence of Coverage, H6830-001 (PDF) -coming soon
  • Dental Benefit Details - English (PDF) - coming soon

If you were enrolled in Ascension Complete last year, this booklet will tell you about changes to your plan’s costs and benefits for the coming year. Please select the document for your plan and county:

For HMO Members

Plan Name CMS #  County Annual Notice of Changes (ANOC)
Wellcare Complete No Premium (HMO) H5398-002 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
Wellcare Complete - Giveback (HMO) H5398- 004 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

 

For PPO Members:

Plan Name CMS#  County Annual Notice of Changes (ANOC)
Wellcare Complete No Premium Open (PPO) H6830-001 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner
Wellcare Complete No Premium Open (PPO) H6830-002 to H6830-001 Butler, Cowley, Harvey, Kingman, Sedgwick, Sumner

If you have any questions please, contact Member Services.