Plan Benefit Materials | Trillium Advantage

Plan Materials and Forms

 

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

Look at your Trillium Advantage member ID card for your plan number and type to view materials for your plan. 

  • View a sample of an Trillium 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 Trillium Advantage ID card or have questions about plan materials, give us a call. We’re here to help.

This booklet gives you a summary of costs and coverage in your plan. 

Please select the document for your plan and county:

For HMO Members:

Plan Name CMS# County  Summary of Benefits
Wellcare Assist (HMO) H6815-037

Lane county

Wellcare No Premium (HMO) H6815-038 Lane county

For HMO D-SNP Members:

Plan Name CMS# County  Summary of Benefits
Wellcare Dual Select (HMO D-SNP) H2174-001

Lane county

For PPO Members:

Plan Name CMS# County  Summary of Benefits
Wellcare Patriot No Premium Open (PPO) H5439-010 Lane county
Wellcare Premium Ultra Open (PPO) H5439-011

Lane county

Wellcare Giveback Open (PPO) H5439-015

Lane county

Wellcare No Premium Open (PPO) H5439-017

Lane county

Wellcare Low Premium Open (PPO) H5439-018 Lane county
Wellcare Low Premium Open (PPO) H5439-019 Lane county

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:

For HMO Members:

Plan Name CMS# County  Evidence of Coverage (EOC)
Wellcare Assist (HMO) H6815-037

Lane county

  • Evidence of Coverage, H6815-037 - English (PDF)
Wellcare No Premium (HMO) H6815-038 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Douglas, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Evidence of Coverage, H6815-038 - English (PDF)

For HMO D-SNP Members:

Plan Name CMS# County  Evidence of Coverage (EOC)
Wellcare Dual Select (HMO D-SNP) H2174-001

Lane county

  • Evidence of Coverage, H2174-001 - English (PDF)

For PPO Members:

Plan Name CMS# County  Evidence of Coverage (EOC)
Wellcare No Premium Open (PPO) H5439-017

Lane county

  • Evidence of Coverage, H5439-017 - English (PDF)
Wellcare Low Premium Open (PPO) H5439-019 Douglas, Jackson, Josephine
  • Evidence of Coverage, H5439-019 - English (PDF)

If you were enrolled in Trillium Medicare Advantage last year, this booklet will tell you about changes to your plan’s costs and benefits for the coming year.

Please select the document for your plan and county:

For HMO Members:

Plan Name CMS# County  Annual Notice of Changes (ANOC)
Wellcare Assist (HMO) H6815-037

Lane county

  • Annual Notice of Coverage, H6815-037 - English (PDF)
Wellcare No Premium (HMO) H6815-038 Benton, Clackamas, Columbia, Coos, Crook, Deschutes, Douglas, Jackson, Jefferson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
  • Annual Notice of Coverage, H6815-038 - English (PDF)

For HMO D-SNP Members:

Plan Name CMS# County  Annual Notice of Changes (ANOC)
Wellcare Dual Select (HMO D-SNP) H2174-001

Lane county

For PPO Members:

Plan Name CMS# County  Annual Notice of Changes (ANOC)
Wellcare No Premium Open (PPO) H5439-017

Lane county

  • Annual Notice of Coverage, H5439-017 - English (PDF)
Wellcare Low Premium Open (PPO) H5439-019 Douglas, Jackson, Josephine
  • Annual Notice of Coverage, H5439-019 - English (PDF)
  •