Plan Benefit Materials | Health Net Medicare Advantage for Oregon and Washington

Plan Materials and Forms

 

Information about plan benefits, services, and drug costs can be found in your plan materials.

Look at your Health Net Medicare Advantage for Oregon and Washington member ID card for your plan number and type to view materials for your plan. 

  • View a sample of an Health Net Member ID Card to see where this information is located.

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

If you don’t have a Health Net Medicare Advantage for Oregon and Washington ID card or have questions about plan materials, give us a call. We’re here to help.

For PPO Members

Plans CMS# County  Summary of Benefits
Wellcare Patriot No Premium Open (PPO) H5439-010 Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Summary of Benefits, H5439-010 - English (PDF)
  • Summary of Benefits, H5439-010 - Korean (PDF)
Wellcare Premium Ultra Open (PPO) H5439-011

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

  • Summary of Benefits, H5439-011 - English (PDF)
  • Summary of Benefits, H5439-011 - Korean (PDF)
Wellcare Low Premium Open (PPO) H5439-018 Benton, Clackamas, Clark, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Summary of Benefits, H5439-018 - English (PDF)
  • Summary of Benefits, H5439-018 - Korean (PDF)
Wellcare Low Premium Open (PPO) H5439-019 Douglas, Jackson, Josephine
  • Summary of Benefits, H5439-019 - English (PDF)
Wellcare Giveback Open (PPO) H5439-015

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

  • Summary of Benefits, H5439-015 – English (PDF)
  • Summary of Benefits, H5439-015 – Korean (PDF)
Wellcare No Premium Open (PPO) H5439-017

Lane

  • Summary of Benefits, H5439-017 - English (PDF)

For HMO Members

Plans  CMS#  County  Summary of Benefits 
Wellcare No Premium (HMO)  H6815-038

Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, YamhillClackamas,
Multnomah & Washington

  • Summary of Benefits, H6815-038 - English (PDF)
Wellcare Assist (HMO) H6815-037 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Douglas, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Summary of Benefits, H6815-037 - English (PDF)

For PPO Members

Plans CMS# County  Evidence of Coverage
Wellcare Patriot No Premium Open (PPO) H5439-010 Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Evidence of Coverage, H5439-010 - English (PDF)
Wellcare Premium Ultra Open (PPO) H5439-011

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

  • Evidence of Coverage, H5439-011 - English (PDF)
  • Evidence of Coverage, H5439-011 - Korean (PDF)
Wellcare Low Premium Open (PPO) H5439-018 Benton, Clackamas, Clark, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Evidence of Coverage, H5439-018 - English (PDF)
  • Evidence of Coverage, H5439-018 - Korean (PDF)
Wellcare Low Premium Open (PPO) H5439-019 Douglas, Jackson, Josephine
  • Evidence of Coverage, H5439-019 - English (PDF)
Wellcare Giveback Open (PPO) H5439-015

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

  • Evidence of Coverage, H5439-015 – English (PDF)
  • Evidence of Coverage, H5439-015 – Korean (PDF)
Wellcare No Premium Open (PPO) H5439-017

Lane

  • Evidence of Coverage, H5439-017 - English (PDF)

For HMO Members

Plans  CMS#  County  Evidence of Coverage 
Wellcare No Premium (HMO)  H6815-038

Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, YamhillClackamas,
Multnomah & Washington

  • Evidence of Coverage, H6815-038 - English (PDF)
Wellcare Assist (HMO) H6815-037 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Douglas, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Evidence of Coverage, H6815-037 - English (PDF)


For PPO Members

Plans CMS# County  Low Income Subsidy
Wellcare Patriot No Premium Open (PPO) H5439-010 Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Annual Notice of Changes, H5439-010 - English (PDF)
Wellcare Premium Ultra Open (PPO) H5439-011

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Wellcare Low Premium Open (PPO) H5439-018 Benton, Clackamas, Clark, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Annual Notice of Changes, H5439-018 - English (PDF)
  • Annual Notice of Changes, H5439-018 - Korean (PDF)
Wellcare Low Premium Open (PPO) H5439-019
Douglas, Jackson, Josephine
  • Annual Notice of Changes, H5439-019 - English (PDF)
Wellcare Giveback Open (PPO) H5439-015

Benton, Clackamas, Clark, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Wellcare No Premium Open (PPO) H5439-017

Lane

 

For HMO Members

Plans  CMS#  County  Annual Notice of Changes
Wellcare No Premium (HMO)  H6815-038

Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, YamhillClackamas,
Multnomah & Washington

  • Annual Notice of Changes, H6815-038 - English (PDF)
Wellcare Assist (HMO) H6815-037
Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Douglas, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Annual Notice of Changes, H6815-037 - English (PDF)