Wellcare: 2023 Enrollment Application Form Corrections

Wellcare has identified some issues with the printed versions of some of the 2023 Enrollment Application documents contained within the Enrollment Resource Guides. The effected Enrollment Guides are currently unavailable for order through CustomPoint, however should be available for order on November 21, 2022. The below updated Enrollment Application Form documents should replace Enrollment Application Form in the printed guides. Please discontinue use of the incorrect Enrollment Application Form immediately.

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Arkansas

The Wellcare Low Premium (HMO) plan on page 3 of the Enrollment Application Form erroneously lists the Plan ID as H9630-008 but it should be listed as H9630-013.

• H9630-013 2023 Wellcare Low Premium (HMO) (English)
• H9630-013 2023 Wellcare Low Premium (HMO) (Spanish)

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Kansas

Wellcare Dual Access Open (PPO D-SNP) on page 3 of the Enrollment Application Form erroneously lists the Plan ID as H9387-003 but it should be listed as H9387-004. Also, the list of counties is incomplete.

• H9387-004 2023 Wellcare Dual Access Open(PPO D-SNP)

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