Texas Plan Benefit Materials

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

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

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

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 - Giveback (HMO)	H6678-003	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Summary of Benefits, H6678-003 - English (PDF) Summary of Benefits, H6678-003 - Spanish (PDF) - coming soon
Wellcare Complete No Premium (HMO)	H6678-004	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Summary of Benefits, H6678-004 - English (PDF) Summary of Benefits, H6678-004 - Spanish (PDF) - coming soon

Plan Name

CMS #

County

Summary of Benefits

Wellcare Complete - Giveback (HMO)

H6678-003

Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson

Summary of Benefits, H6678-003 - English (PDF)

Summary of Benefits, H6678-003 - Spanish (PDF) - coming soon

Wellcare Complete No Premium (HMO)

H6678-004

Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson

Summary of Benefits, H6678-004 - English (PDF)

Summary of Benefits, H6678-004 - Spanish (PDF) - coming soon

For PPO Members:

Plan Name	CMS #	County	Summary of Benefits
Wellcare Complete No Premium Open (PPO)	H9357- 001	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Summary of Benefits, H9357-001 - English (PDF) Summary of Benefits, H9357-001 - Spanish (PDF) - coming soon

Plan Name

CMS #

County

Summary of Benefits

Wellcare Complete No Premium Open (PPO)

H9357- 001

Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson

Summary of Benefits, H9357-001 - English (PDF)

Summary of Benefits, H9357-001 - Spanish (PDF) - coming soon

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
Wellcare Complete - Giveback (HMO)	H6678-003	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Evidence of Coverage, H6678-003 - English (PDF) Evidence of Coverage, H6678-003 - Spanish (PDF) - coming soon Dental Benefit Details - English (PDF) - coming soon
Wellcare Complete No Premium (HMO)	H6678-004	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Evidence of Coverage, H6678-004 - English (PDF) Evidence of Coverage, H6678-004 - Spanish (PDF) - coming soon Dental Benefit Details - English (PDF) - coming soon

Plan Name

CMS #

County

Evidence of Coverage

Wellcare Complete - Giveback (HMO)

H6678-003

Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson

Evidence of Coverage, H6678-003 - English (PDF)

Evidence of Coverage, H6678-003 - Spanish (PDF) - coming soon

Dental Benefit Details - English (PDF) - coming soon

Wellcare Complete No Premium (HMO)

H6678-004

Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson

Evidence of Coverage, H6678-004 - English (PDF)

Evidence of Coverage, H6678-004 - Spanish (PDF) - coming soon

Dental Benefit Details - English (PDF) - coming soon

For PPO Members:

Plan Name	CMS #	County	Evidence of Coverage
Wellcare Complete No Premium Open (PPO)	H9357- 001	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Evidence of Coverage, H9357- 001 – English (PDF) Evidence of Coverage, H9357- 001 – Spanish (PDF) - coming soon Dental Benefit Details - English (PDF) - coming soon

Plan Name

CMS #

County

Evidence of Coverage

Wellcare Complete No Premium Open (PPO)

H9357- 001

Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson

Evidence of Coverage, H9357- 001 – English (PDF)
Evidence of Coverage, H9357- 001 – Spanish (PDF) - coming soon

Dental Benefit Details - English (PDF) - coming soon

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	Annual Notice of Changes (ANOC)
Wellcare Complete - Giveback (HMO)	H6678-001 to H6678-003	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Annual Notice of Changes, H6678-001 and H6678 - 003 English (PDF) Annual Notice of Changes, H6678-001 to H6678-003 - Spanish (PDF)
Wellcare Complete Giveback (HMO)	H6678-003	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Annual Notice of Changes, H6678-003 - English (PDF) Annual Notice of Changes, H6678-003 - Spanish (PDF)
Wellcare Complete No Premium (HMO)	H6678-004	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Annual Notice of Changes, H6678-004 - English (PDF) Annual Notice of Changes, H6678-004 - Spanish (PDF)
Wellcare Complete No Premium (HMO)	H6678-002 to H6678-004	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Annual Notice of Changes, H6678-002 to H6678-004 - English (PDF) Annual Notice of Changes, H6678-002 to H6678-004 - Spanish (PDF)

For PPO Members:

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Wellcare Complete No Premium Open (PPO)	H9357- 001	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Annual Notice of Changes, H9357-001 - English (PDF) Annual Notice of Changes, H9357-001 - Spanish (PDF)
Wellcare Complete No Premium Open (PPO)	H9357- 002 to H9357- 001	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Annual Notice of Changes, H9357- 002 and H9357-001 - English (PDF) Annual Notice of Changes,H9357- 002 and H9357-001 - Spanish (PDF)
Wellcare Complete No Premium Open (PPO)	H9357- 003 to H9357- 001	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Annual Notice of Changes, H9357- 003 to H9357-001 - English (PDF) Annual Notice of Changes, H9357- 003 to H9357-001 - Spanish (PDF)
Wellcare Complete No Premium Open (PPO)	H9357- 004 to H9357- 001	Bastrop, Bell, Burnet, Caldwell, Coryell, Hays, Hill, Lampasas, Lee, Llano, McLennan, Travis, Williamson	Annual Notice of Changes, H9357- 004 to H9357-001 - English (PDF) Annual Notice of Changes, H9357- 004 to H9357-001 - Spanish (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Seton Reward (HMO)	H6678-001	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Summary of Benefits, H6678-001 - English (PDF) Summary of Benefits, H6678-001 - Spanish (PDF)
Ascension Complete Seton Secure (HMO)	H6678-002	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Summary of Benefits, H6678-002 - English (PDF) Summary of Benefits, H6678-002 - Spanish (PDF)
Ascension Complete Providence Reward (HMO)	H6678-003	Bell, Coryell, Hill, Lampasas, McLennan	Summary of Benefits, H6678-003 - English (PDF) Summary of Benefits, H6678-003 - Spanish (PDF)
Ascension Complete Providence Secure (HMO)	H6678-004	Bell, Coryell, Hill, Lampasas, McLennan	Summary of Benefits, H6678-004 - English (PDF) Summary of Benefits, H6678-004 - Spanish (PDF)

Plan Name	CMS #	County	Summary of Benefits
Ascension Complete Seton Access Plus (PPO)	H9357- 001	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Summary of Benefits, H9357-001 - English (PDF) Summary of Benefits, H9357-001 - Spanish (PDF)
Ascension Complete Seton Access (PPO)	H9357- 002	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Summary of Benefits, H9357-002 - English (PDF) Summary of Benefits, H9357-002 - Spanish (PDF)
Ascension Complete Providence Access Plus (PPO)	H9357- 003	Bell, Coryell, Hill, Lampasas, McLennan	Summary of Benefits, H9357-003 - English (PDF) Summary of Benefits, H9357-003 - Spanish (PDF)
Ascension Complete Providence Access (PPO)	H9357- 004	Bell, Coryell, Hill, Lampasas, McLennan	Summary of Benefits, H9357-004 - English (PDF) Summary of Benefits, H9357-004 - Spanish (PDF)

Plan Name	CMS #	County	Evidence of Coverage
Ascension Complete Seton Reward (HMO)	H6678-001	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Evidence of Coverage, H6678-001 - English (PDF) Evidence of Coverage, H6678-001 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Ascension Complete Seton Secure (HMO)	H6678-002	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Evidence of Coverage, H6678-002 - English (PDF) Evidence of Coverage, H6678-002 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Ascension Complete Providence Reward (HMO)	H6678-003	Bell, Coryell, Hill, Lampasas, McLennan	Evidence of Coverage, H6678-003 - English (PDF) Evidence of Coverage, H6678-003 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Ascension Complete Providence Secure (HMO)	H6678-004	Bell, Coryell, Hill, Lampasas, McLennan	Evidence of Coverage, H6678-004 - English (PDF) Evidence of Coverage, H6678-004 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name	CMS #	County	Evidence of Coverage
Ascension Complete Seton Access Plus (PPO)	H9357- 001	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Evidence of Coverage, H9357- 001 – English (PDF) Evidence of Coverage, H9357- 001 – Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Ascension Complete Seton Access (PPO)	H9357- 002	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Evidence of Coverage, H9357-002 - English (PDF) Evidence of Coverage, H9357-002 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Ascension Complete Providence Access Plus (PPO)	H9357- 003	Bell, Coryell, Hill, Lampasas, McLennan	Evidence of Coverage, H9357-003 - English (PDF) Evidence of Coverage, H9357-003 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)
Ascension Complete Providence Access (PPO)	H9357- 004	Bell, Coryell, Hill, Lampasas, McLennan	Evidence of Coverage, H9357-004 - English (PDF) Evidence of Coverage, H9357-004 - Spanish (PDF) Dental Benefit Details - English (PDF) Dental Benefit Details - Spanish (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete Seton Reward (HMO)	H6678-001	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Annual Notice of Changes, H6678-001 - English (PDF) Annual Notice of Changes, H6678-001 - Spanish (PDF)
Ascension Complete Seton Secure (HMO)	H6678-002	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Annual Notice of Changes, H6678-002 - English (PDF) Annual Notice of Changes, H6678-002 - Spanish (PDF)
Ascension Complete Providence Reward (HMO)	H6678-003	Bell, Coryell, Hill, Lampasas, McLennan	Annual Notice of Changes, H6678-003 - English (PDF) Annual Notice of Changes, H6678-003 - Spanish (PDF)
Ascension Complete Providence Secure (HMO)	H6678-004	Bell, Coryell, Hill, Lampasas, McLennan	Annual Notice of Changes, H6678-004 - English (PDF) Annual Notice of Changes, H6678-004 - Spanish (PDF)

Plan Name	CMS #	County	Annual Notice of Changes (ANOC)
Ascension Complete Seton Access Plus (PPO)	H9357- 001	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Annual Notice of Changes, H9357-001 - English (PDF) Annual Notice of Changes, H9357-001 - Spanish (PDF)
Ascension Complete Seton Access (PPO)	H9357- 002	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Annual Notice of Changes, H9357-002 - English (PDF) Annual Notice of Changes, H9357-002 - Spanish (PDF)
Ascension Complete Providence Access Plus (PPO)	H9357- 003	Bell, Coryell, Hill, Lampasas, McLennan	Annual Notice of Changes, H9357-003 - English (PDF) Annual Notice of Changes, H9357-003 - Spanish (PDF)
Ascension Complete Providence Access (PPO)	H9357- 004	Bell, Coryell, Hill, Lampasas, McLennan	Annual Notice of Changes, H9357-004 - English (PDF) Annual Notice of Changes, H9357-004 - Spanish (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete Seton Reward (HMO)	H6678-001	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Welcome Kit, H6678-001 - English (PDF)
Ascension Complete Seton Secure (HMO)	H6678-002	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Welcome Kit, H6678-002 - English (PDF)
Ascension Complete Providence Reward (HMO)	H6678-003	Bell, Coryell, Hill, Lampasas, McLennan	Welcome Kit, H6678-003 - English (PDF)
Ascension Complete Providence Secure (HMO)	H6678-004	Bell, Coryell, Hill, Lampasas, McLennan	Welcome Kit, H6678-004 - English (PDF)

Plan Name	CMS #	County	Welcome Kit
Ascension Complete Seton Access Plus (PPO)	H9357- 001	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Welcome Kit, H9357- 001 – English (PDF)
Ascension Complete Seton Access (PPO)	H9357- 002	Bastrop, Burnet, Caldwell, Hays, Lee, Llano, Travis, Williamson	Welcome Kit, H9357-002 - English (PDF)
Ascension Complete Providence Access Plus (PPO)	H9357- 003	Bell, Coryell, Hill, Lampasas, McLennan	Welcome Kit, H9357-003 - English (PDF)
Ascension Complete Providence Access (PPO)	H9357- 004	Bell, Coryell, Hill, Lampasas, McLennan	Welcome Kit, H9357-004 - English (PDF)

If you have any questions please, contact Member Services.

Texas Plan Benefit Materials

Summary of Benefits (SB)

For HMO Members:

For PPO Members:

Evidence Of Coverage (EOC)

For HMO Members:

For PPO Members:

Annual Notice of Changes (ANOC)

For HMO Members:

For PPO Members:

Texas Plan Benefit Materials

Summary of Benefits

For HMO Members:

For PPO Members:

Evidence of Coverage (EOC)

For HMO Members:

For PPO Members:

Annual Notice of Changes (ANOC)

For HMO Members:

For PPO Members:

Addendum To 2023 Medicare Advantage Benefits

Over-the-Counter Catalog

Member Newsletter

Extra Help

Welcome Kit

For HMO Members:

For PPO Members: