Resources / Materials

• 2024 SC H1723 MMP Member Handbook - English (PDF)
• 2024 SC H1723 MMP Member Handbook - Spanish (PDF)

• How to request a Member Handbook by Mail - English (PDF)
• Cómo solicitar un Manual del afiliado por correo - Español (PDF)

• 2024 Summary of Benefits - English (PDF)
• Resumen de Beneficios para 2024 - Spanish (PDF)

• 2024 Annual Notice of Changes - English (PDF)
• 2024 Aviso Anual de Cambios - Spanish (PDF)

• Prescription Drug Claim Form-English (PDF)
• Prescription Drug Claim Form-Spanish (PDF)

• Express Scripts Mail Order Form-English (PDF)
• Express Scripts Mail Order Form-Spanish (PDF)

• List of Drugs (Formulary)

• List of Drugs Change Notice

• Drug Coverage Determination
• Drug Redeterminations (Appeals)

• Part D Prior Authorization Criteria Form

• Part D Step Therapy Criteria Form

• Appointment of Representative Form-English (PDF)Oct 1, 2023
• Appointment of Representative Form Spanish (PDF)Oct 1, 2023

Your current health plan offers an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. The catalog includes a list of OTC items that you can order and have mailed directly to your home.

There are three ways to order—in store, online, or by phone.  You can also download the new OTC Health Solutions App. The app is an easy and quick way to scan items in store, view your benefit information and items offered, process an order, review past orders, and look up account information. Ordering is easy. Just follow the steps in your plan's catalog.

Click on the OTC Catalog link below for all of your benefit details:

• Over-the-Counter Catalog - English (PDF)
• Over-the-Counter Catalog - Spanish (PDF)

You can also connect to CVS® OTC Health Solutions to review products and store information.

Preventive Guidelines

Preventive guidelines are based on the health needs and opportunities for improvement identified as part of the Quality Assurance Program Improvement (QAPI) program. When possible, Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) adopts preventive guidelines that are published by nationally recognized organizations or government institutions. These guidelines may also be a statewide collaborative and/or a consensus of healthcare professionals in the applicable field.

• Recommended Adult Immunization Schedule for Adults 19 Years or Older, United States, 2022 (PDF)
• The Adult Well Male Examination
• Prevention and Control of Seasonal Influenza with Vaccines-Recommendations of the Advisory Committee on Immunization Practices - United States, 2021-22 Influenza Season
• Well-Woman Recommendations (PDF)
• Wellcare Prime QI Program Information (PDF)

Links

(Please note: By clicking on the links below you will be leaving the Wellcare Prime by Absolute Total Care's website.)

• CMS Best Available Evidence (BAE) policy
• File a complaint directly with CMS
• Information to help prevent, report and stop Fraud, Waste, and Abuse
• Office for Civil Rights
• The Office of the Medicare Ombudsman (OMO)

• Covered Diabetes Testing Supplies (PDF)

• Part B Step Therapy - English (PDF)
• Part B Step Therapy - Spanish (PDF)

• 2023 SC H1723 MMP Member Handbook - English (PDF)
• 2023 SC H1723 MMP Member Handbook - Spanish (PDF)

• How to request a Member Handbook by Mail - English (PDF) - last updated Sep 19, 2022
• Cómo solicitar un Manual del afiliado por correo - Español (PDF) - last updated Oct 1, 2022

• 2023 Summary of Benefits - English (PDF)
• Resumen de Beneficios para 2023 - Spanish (PDF)

• 2023 Annual Notice of Changes - English (PDF)
• 2023 Aviso Anual de Cambios - Spanish (PDF)

• Authorization to Disclose Health Information - English (PDF)
• Authorization to Disclose Health Information - Spanish (PDF)

• Revocation of Authorization to Disclose Health Information - English (PDF)
• Revocation of Authorization to Disclose Health Information - Spanish (PDF)

• CMS-1696 Appointment of Representative Form (PDF)

• Member Part C Appeal Form (PDF)

• Part D Appeal (Redetermination) Form

• Member Complaint Form (PDF)

• CVS Caremark Form - English (PDF)
• CVS Caremark Form - Spanish (PDF)

• Prescription Claim Form – English (PDF)
• Prescription Claim Form – Spanish (PDF)

Your current plan offers an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. This catalog includes a list of OTC items that you can order to be mailed to your home. Check the catalog for your benefit details and item limits.

• Ordering is easy. Just follow the steps in your plan's catalog. 
• Over-the-Counter Catalog - English / Spanish (PDF)

Don't want to wait? You may be able to pick up your OTC products from a CVS® store near you.  Please note this does not include CVS® locations inside of Target stores.

Connect to the CVS® OTC Health Solutions website to review available products and store information.

Preventive Guidelines

Preventive guidelines are based on the health needs and opportunities for improvement identified as part of the Quality Assurance Program Improvement (QAPI) program. When possible, Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) adopts preventive guidelines that are published by nationally recognized organizations or government institutions. These guidelines may also be a statewide collaborative and/or a consensus of healthcare professionals in the applicable field.

• Recommended Adult Immunization Schedule for Adults 19 Years or Older, United States, 2023 (PDF)
• The Adult Well Male Examination
• Prevention and Control of Seasonal Influenza with Vaccines-Recommendations of the Advisory Committee on Immunization Practices - United States, 2022-23 Influenza Season
• Well-Woman Preventive Visits (PDF)

Links

(Please note: By clicking on the links below you will be leaving the Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan).)

• CMS Best Available Evidence (BAE) policy
• File a complaint directly with CMS
• Information to help prevent, report and stop Fraud, Waste, and Abuse
• Office for Civil Rights
• The Office of the Medicare Ombudsman (OMO)

• Covered Diabetes Testing Supplies (PDF)

• Part B Step Therapy (PDF)