Formulary
2025 Formulary
List of Drugs Change Notice (Available February 2025)
Formulario 2025
Annual Notice of Change
Annual Notice of Change for Plan 003
Annual Notice of Change for Plan 003 (Albanian)
Annual Notice of Change for Plan 003 (Arabic)
Annual Notice of Change for Plan 003 (Bengali)
Annual Notice of Change for Plan 003 (Chinese)
Annual Notice of Change for Plan 003 (French)
Annual Notice of Change for Plan 003 (Greek)
Annual Notice of Change for Plan 003 (Italian)
Annual Notice of Change for Plan 003 (Polish)
Annual Notice of Change for Plan 003 (Russian)
Annual Notice of Change for Plan 003 (Spanish)
Annual Notice of Change for Plan 003 (Tagalog)
Annual Notice of Change for Plan 003 (Urdu)
Annual Notice of Change for Plan 003 (Yiddish)
Annual Notice of Change for Plan 008
Annual Notice of Change for Plan 008 (Albanian)
Annual Notice of Change for Plan 008 (Arabic)
Annual Notice of Change for Plan 008 (Bengali)
Annual Notice of Change for Plan 003 (Chinese)
Annual Notice of Change for Plan 003 (French)
Annual Notice of Change for Plan 003 (Greek)
Annual Notice of Change for Plan 003 (Italian)
Annual Notice of Change for Plan 003 (Polish)
Annual Notice of Change for Plan 003 (Russian)
Annual Notice of Change for Plan 008 (Spanish)
Annual Notice of Change for Plan 003 (Tagalog)
Annual Notice of Change for Plan 003 (Urdu)
Annual Notice of Change for Plan 003 (Yiddish)
Evidence of Coverage
This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2025. It explains how to get coverage for the health care services and prescription drugs you need.
Evidence of Coverage
Evidence of Coverage (Albanian)
Evidence of Coverage (Arabic)
Evidence of Coverage (Bengali)
Evidence of Coverage (Chinese)
Evidence of Coverage (Greek)
Evidence of Coverage (Italian)
Evidence of Coverage (Korean)
Evidence of Coverage (Polish)
Evidence of Coverage (Russian)
Evidence of Coverage (Spanish)
Evidence of Coverage (Tagalog)
Evidence of Coverage (Urdu)
Evidence of Coverage (Yiddish)
Summary of Benefits
You can use this document to compare Wellcare By Fidelis Care programs and the Original Medicare Program. The charts in this booklet list important health benefits. For each benefit, you can see what our program covers and what the Original Medicare Program covers. Our members receive all of the benefits that the Original Medicare Program offers but we also offer additional benefits to help you stay healthy.
Summary of Benefits
Summary of Benefits (Albanian)
Summary of Benefits (Arabic)
Summary of Benefits (Bengali)
Summary of Benefits (Chinese)
Summary of Benefits (French)
Summary of Benefits (Greek)
Summary of Benefits (Italian)
Summary of Benefits (Korean)
Summary of Benefits (Polish)
Summary of Benefits (Russian)
Summary of Benefits (Spanish)
Summary of Benefits (Tagalog)
Summary of Benefits (Urdu)
Summary of Benefits (Yiddish)
Dental Benefit Details
Dental Benefit Details
Dental Benefit Details (Albanian)
Dental Benefit Details (Arabic)
Dental Benefit Details (Bengali)
Dental Benefit Details (Chinese)
Dental Benefit Details (French)
Dental Benefit Details (Greek)
Dental Benefit Details (Italian)
Dental Benefit Details (Korean)
Dental Benefit Details (Polish)
Dental Benefit Details (Russian)
Dental Benefit Details (Spanish)
Dental Benefit Details (Tagalog)
Dental Benefit Details (Urdu)
Dental Benefit Details (Yiddish)
Additional Benefits
2025 Alternative Covered Drugs
2025 Covered Diabetes Meters and Testing Supplies
2025 National Medicare Handbook
Medicare Handbook Insert - Social Care Network (SCN)
Member Notice - Social Care Network (SCN)
Over-the-Counter Benefits
Wellcare Spendables™ Card
Out-of-Network Coverage Rules
It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which Wellcare By Fidelis Care authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out-of-area coverage.