Understanding Your WellCare Benefits
Overview
WellCare is designed to provide access to preventive healthcare services, virtual doctor visits, and prescription savings programs.
The plan focuses on helping members stay healthy through preventive care while also providing 24/7 access to virtual medical care for many common illnesses and health concerns.
What's Included With WellCare?
WellCare includes three primary benefit categories:
Preventive Care
Virtual Urgent Care
Prescription Discounts
Preventive Care Coverage
Preventive care services are covered when received from participating providers. Preventive care is designed to help identify health concerns early and support ongoing wellness.
Examples of covered preventive services include:
Adult Preventive Care
- Annual wellness visits
- Blood pressure screenings
- Cholesterol screenings
- Diabetes screenings
- Depression screenings
- Cancer screenings
- Recommended immunizations and vaccines
Women's Preventive Care
- Well-woman visits
- Mammograms
- Cervical cancer screenings
- Prenatal preventive screenings
- Breastfeeding support and counseling
Children's Preventive Care
- Well-child visits
- Developmental screenings
- Vision screenings
- Hearing screenings
- Childhood immunizations
Preventive care is intended for routine health maintenance and screening before symptoms develop.
Virtual Urgent Care
WellCare includes unlimited access to Recuro Virtual Urgent Care with a $0 copay. Members can connect with licensed healthcare providers 24 hours a day, 7 days a week using phone or video visits.
Common Conditions Treated
Virtual Urgent Care may be appropriate for:
- Colds and flu
- Allergies
- Rashes
- Fever
- Headaches
- Nausea
- Respiratory infections
- Urinary tract infections (UTIs)
- Other common non-emergency conditions
When medically appropriate, prescriptions can be sent directly to your preferred pharmacy.
Prescription Discounts
WellCare includes access to the PureRx Prescription Discount Program. Members can present their ID card at participating pharmacies to receive discounts on many FDA-approved prescription medications. Discounts may be available at more than 60,000 retail pharmacies nationwide.
Important Note
The PureRx program is a prescription discount program, not traditional prescription insurance coverage. The amount you save may vary depending on the medication and participating pharmacy.
Services Not Included Under WellCare
Understanding what is not covered is just as important as understanding what is covered.
WellCare generally does not include coverage for:
Doctor Office Visits
- Primary care office visits
- Non-preventive physical examinations
- Routine sick visits
Specialist Care
Examples include:
- Cardiologists
- Dermatologists
- Orthopedic specialists
- Gastroenterologists
Urgent Care Centers
In-person urgent care facilities are not covered. Members should use the included Virtual Urgent Care benefit when appropriate.
Diagnostic Testing
Examples include:
- MRI scans
- CT scans
- Diagnostic X-rays
- Non-preventive laboratory testing
Hospital and Emergency Services
Examples include:
- Emergency room visits
- Ambulance transportation
- Hospital admissions
- Surgery
- Inpatient care
These services are generally excluded under the WellCare plan.
How To Access Your Benefits
Find a Provider
Preventive care services are available through participating providers in the PHCS network.
Access Virtual Care
Members can access Virtual Urgent Care through:
- The HealthWallet mobile app
- Phone support through Recuro
Access Prescription Discounts
Present your ID card at participating pharmacies when filling prescriptions.
Quick Summary
Included
✓ Preventive care
✓ Wellness screenings
✓ Vaccinations
✓ Virtual urgent care
✓ Prescription discounts
Not Included
✗ Primary care office visits
✗ Specialist visits
✗ In-person urgent care
✗ Diagnostic testing
✗ Hospital services
✗ Emergency room services
✗ Surgery
The WellCare plan is focused on preventive care, virtual healthcare access, and prescription savings while keeping healthcare coverage affordable and simple.