Thank you for being a loyal customer of WellCare Health Plans.  On this page you will be able to quickly find all the forms that you as a member will need.  Here is a PDF link to our most current member newsletter. 

To view an online version of your summary of benefits or evidence of coverage please click on the Our Plans tab at the end of this paragraph.  You will be prompted to select your state and county that you live in.  Once you make that selection please choose the plan that you are enrolled in by clicking on the words View Details to the right of the Plan Name.  The page will refresh itself and then you can scroll to the bottom of the page to find a link to the Evidence of Coverage or the Summary of Benefits.

Fitness and Provider Directories

Fitness Directory(PDF Listing)

Provider Directory (PDF Listing)

To find a dental, hearing or vision provider near you please click on the Our Plans tab at the top of the page and then click on Find A Provider.

Coverage Determination Forms

Prescription Drug Extra Help Checklist

Redetermination Request Form

Reconsideration Request Form

Appointment of Representation Form

Prescription Drug Forms and Formulary

Prescription Drug Coverage Determination Request Form

Injectable/Infusion Prescription Order Form

Provider Pharmacy Appeal Form

Prescription Drugs Direct Member Reimbursement Form

Formulary (PDF Listing)

Formulary Update (PDF Listing)

To locate a pharmacy near you click on the Pharmacy tab at the top of the page.

Have your premium deducted directly from your checking account by filling out the Electronic Funds Transfer form.