Resources / Materials
To access your 2023 Wellcare Dual Align 129 plan materials including the Annual Notice of Change sent to you in late September, please visit our Wellcare by Health Net site.
Los Angeles
- Los Angeles ANOC - English (PDF)
- Los Angeles ANOC - Español (PDF)
- Los Angeles ANOC - Arabic العربية (PDF)
- Los Angeles ANOC - Armenian Հայերեն (PDF)
- Los Angeles ANOC - Cambodian ខ្មែរ (PDF)
- Los Angeles ANOC - Chinese Mandarin 中文 (PDF)
- Los Angeles ANOC - Farsi/Persian فارسی (PDF)
- Los Angeles ANOC – Korean 한국어 (PDF)
- Los Angeles ANOC - Russian Русский язык (PDF)
- Los Angeles ANOC - Tagalog (PDF)
- Los Angeles ANOC - Vietnamese Tiếng Việt (PDF)
San Diego
- San Diego ANOC - English (PDF)
- San Diego ANOC - Español (PDF)
- San Diego ANOC - Arabic العربية (PDF)
- San Diego ANOC - Chinese Mandarin 中文 (PDF)
- San Diego ANOC - Farsi/Persian فارسی (PDF)
- San Diego ANOC - Tagalog (PDF)
- San Diego ANOC - Vietnamese Tiếng Việt (PDF)
Wellcare Dual Align 129 (HMO D-SNP) H3237-001 Los Angeles
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129 English (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129 - Spanish (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129- Armenian (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129 - Arabian (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129- Cambodian (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129- Chinese (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129- Farsi (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129- Korean (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129- Russian (PDF) - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129- Tagalog - last updated Oct 5, 2022
- Annual Notice of Changes (ANOC), H3237-001 to H0562-129- Vietnamese (PDF) - last updated Oct 5, 2022
Wellcare Dual Align 129 (HMO D-SNP) H3237-002 San Diego
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129 English (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129 - Spanish (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129- Armenian (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129 - Arabian (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129- Cambodian (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129- Chinese (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129- Farsi (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129- Korean (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129- Russian (PDF) - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129- Tagalog - last updated Oct 6, 2022
- Annual Notice of Changes (ANOC), H3237-002 to H0562-129- Vietnamese (PDF) - last updated Oct 6, 2022
Los Angeles
- Los Angeles Member Handbook - English (PDF)
- Los Angeles Member Handbook - Español (PDF)
- Los Angeles Member Handbook - Arabic العربية (PDF)
- Los Angeles Member Handbook - Armenian Հայերեն (PDF)
- Los Angeles Member Handbook - Cambodian ខ្មែរ (PDF)
- Los Angeles Member Handbook - Chinese Mandarin 中文 (PDF)
- Los Angeles Member Handbook - Farsi/Persian فارسی (PDF)
- Los Angeles Member Handbook - Korean 한국어 (PDF)
- Los Angeles Member Handbook - Russian Русский язык (PDF)
- Los Angeles Member Handbook - Tagalog (PDF)
- Los Angeles Member Handbook - Vietnamese Tiếng Việt (PDF)
San Diego
- San Diego Member Handbook - English (PDF)
- San Diego Member Handbook - Spanish (PDF)
- San Diego Member Handbook - Arabic العربية (PDF)
- San Diego Member Handbook - Chinese (PDF)
- San Diego Member Handbook - Farsi/Persian فارسی (PDF)
- San Diego Member Handbook - Tagalog (PDF)
- San Diego Member Handbook - Vietnamese Tiếng Việt (PDF)
Los Angeles
- Los Angeles Summary of Benefits - English (PDF)
- Los Angeles Summary of Benefits - Spanish - Español (PDF)
- Los Angeles Summary of Benefits - Arabic - العربية (PDF)
- Los Angeles Summary of Benefits - Armenian - Հայերեն (PDF)
- Los Angeles Summary of Benefits - Cambodian - ខ្មែរ (PDF)
- Los Angeles Summary of Benefits - Chinese Mandarin - 中文 (PDF)
- Los Angeles Summary of Benefits - Farsi/Persian - فارسی (PDF)
- Los Angeles Summary of Benefits - Korean - 한국어 (PDF)
- Los Angeles Summary of Benefits - Russian - Русский (PDF)
- Los Angeles Summary of Benefits - Tagalog (PDF)
- Los Angeles Summary of Benefits - Vietnamese - Tiếng Việt (PDF)
San Diego
- San Diego Summary of Benefits - English - (PDF)
- San Diego Summary of Benefits - Spanish - Español (PDF)
- San Diego Summary of Benefits - Arabic - العربية (PDF)
- San Diego Summary of Benefits - Chinese Mandarin - 中文 (PDF)
- San Diego Summary of Benefits - Farsi/Persian - فارسی (PDF)
- San Diego Summary of Benefits - Tagalog (PDF)
- San Diego Summary of Benefits - Vietnamese - Tiếng Việt (PDF)
Los Angeles and San Diego
Updated: December 01, 2022
- List of Drugs - English (PDF)
- List of Drugs - Spanish (PDF)
- List of Drugs - Arabic (PDF)
- List of Drugs - Armenian (PDF)
- List of Drugs - Chinese Mandarin (PDF)
- List of Drugs - Cambodian (PDF)
- List of Drugs - Farsi/Persian (PDF)
- List of Drugs - Korean (PDF)
- List of Drugs - Russian (PDF)
- List of Drugs - Tagalog (PDF)
- List of Drugs - Vietnamese (PDF)
Mail Order Pharmacy
Medication Therapy Management
Prescription Claims
Transition of Care Form
Scope of Appointment
Notice of Privacy Practices
- Notice of Privacy Practices - English (PDF)
- Notice of Privacy Practices - Spanish (PDF)
- Notice of Privacy Practices - Arabic - العربية (PDF)
- Notice of Privacy Practices - Armenian - Հայերեն (PDF)
- Notice of Privacy Practices - Cambodian - ខ្មែរ (PDF)
- Notice of Privacy Practices - Chinese - 中文 (PDF)
- Notice of Privacy Practices - Farsi/Persian - فارسی (PDF)
- Notice of Privacy Practices - Korean - 한국어 (PDF)
- Notice of Privacy Practices - Russian - Русский (PDF)
- Notice of Privacy Practices - Tagalog (PDF)
- Notice of Privacy Practices - Vietnamese - Tiếng Việt (PDF)
Confidential Communication Request
To request request special, confidential handling of your medical information, also called protected health information (PHI) please visit our Confidential Communication Request Form Webpage.
Your current plan may have an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. This catalog includes a list of OTC items that you can order to be mailed to your home. Check the catalog for item limits.
- Ordering is easy. Just follow the steps in your plan's catalog.
- Over-the-Counter Catalog - English / Spanish (PDF)
Don't want to wait? You may be able to pick up your OTC products from a CVS store near you. Please note this does not include CVS locations inside of Target stores.
Connect to the CVS OTC website to review available products and store information.
- Advance Directive Flyer - English (PDF)
- Advance Directive Flyer - Spanish (PDF)
- Advance Directive Flyer - Arabic - العربية (PDF)
- Advance Directive Flyer - Armenian - Հայերեն (PDF)
- Advance Directive Flyer - Cambodian - ខ្មែរ (PDF)
- Advance Directive Flyer - Chinese - 中文 (PDF)
- Advance Directive Flyer - Farsi/Persian - فارسی (PDF)
- Advance Directive Flyer - Korean - 한국어 (PDF)
- Advance Directive Flyer - Russian - Русский (PDF)
- Advance Directive Flyer - Tagalog (PDF)
- Advance Directive Flyer - Vietnamese (PDF)
Procedure Code |
Procedure Description |
C9050 |
EMAPALUMAB-LZSG |
J0129 |
ABATACEPT INJECTION |
J0178 |
AFLIBERCEPT INJECTION |
J0584 |
BUROSUMAB-TWZA 1M |
J0585 |
ONABOTULINUMTOXINA |
J0604 |
CINACALCET, ESRD ON DIALYSIS |
J0717 |
CERTOLIZUMAB PEGOL INJ 1MG |
J0800 |
CORTICOTROPIN INJECTION |
J0897 |
DENOSUMAB INJECTION |
J1300 |
ECULIZUMAB INJECTION |
J1428 |
ETEPLIRSEN, 10 MG |
J1459 |
IVIG PRIVIGEN 500 MG |
J1555 |
CUVITRU, 100 MG |
J1556 |
IMM GLOB BIVIGAM, 500MG |
J1557 |
GAMMAPLEX INJECTION |
J1559 |
HIZENTRA INJECTION |
J1561 |
GAMUNEX-C/GAMMAKED |
J1566 |
IMMUNE GLOBULIN, POWDER |
J1568 |
OCTAGAM INJECTION |
J1569 |
GAMMAGARD LIQUID INJECTION |
J1572 |
FLEBOGAMMA INJECTION |
J1575 |
HYQVIA 100MG IMMUNEGLOBULIN |
J1599 |
IVIG NON-LYOPHILIZED, NOS |
J1602 |
GOLIMUMAB FOR IV USE 1MG |
J1745 |
INFLIXIMAB (REMICADE) |
J1930 |
LANREOTIDE INJECTION |
J2323 |
NATALIZUMAB INJECTION |
J2350 |
OCRELIZUMAB, 1 MG |
J2353 |
OCTREOTIDE INJECTION, DEPOT |
J2357 |
OMALIZUMAB INJECTION |
J2503 |
PEGAPTANIB SODIUM INJECTION |
J2778 |
RANIBIZUMAB INJECTION |
J3262 |
TOCILIZUMAB, 1 MG |
J3304 |
TRIAMCINOLONE ACE XR 1MG |
J3357 |
USTEKINUMAB SUB CU 1 MG |
J3380 |
VEDOLIZUMAB |
J3396 |
VERTEPORFIN INJECTION |
J7189 |
FACTOR VIIA |
J7318 |
DUROLANE 1 MG |
J7320 |
GENVISC 850, 1MG |
J7321 |
HYALGAN SUPARTZ VISCO-3 DOSE |
J7322 |
HYMOVIS INJECTION 1 MG |
J7323 |
EUFLEXXA INJ PER DOSE |
J7324 |
ORTHOVISC INJ PER DOSE |
J7325 |
SYNVISC OR SYNVISC-ONE |
J7326 |
GEL-ONE |
J7327 |
MONOVISC INJ PER DOSE |
J7328 |
GELSYN-3 INJECTION 0.1 MG |
J7329 |
TRIVISC 1 MG |
J9022 |
ATEZOLIZUMAB,10 MG |
J9145 |
INJECTION DARATUMUMAB 10 MG |
J9173 |
DURVALUMAB, 10 MG |
J9176 |
ELOTUZUMAB, 1MG |
J9308 |
RAMUCIRUMAB |
J9311 |
RITUXIMAB, HYALURONIDASE |
J9355 |
TRASTUZUMAB INJECTION |
Q2043 |
SIPULEUCEL-T AUTO CD54+ |
Q5103 |
INFLIXIMAB (INFLECTRA) |
Q5104 |
INFLIXIMAB (RENFLEXIS) |
- Fact Sheet H3237-001 - English (PDF)
- Fact Sheet H3237-001 - Spanish (PDF)
- Fact Sheet H3237-001 - Chinese (PDF)
- Fact Sheet H3237-001 - Korean (PDF)
- Fact Sheet H3237-001 - Russian (PDF)
- Fact Sheet H3237-001 - Vietnames (PDF)
- Benefit Highlights H3237-001 - English (PDF)
- Benefit Highlights H3237-001 - Spanish (PDF)
- Benefit Highlights H3237-001 - Chinese (PDF)
- Benefit Highlights H3237-001 - Korean (PDF)
- Benefit Highlights H3237-001 - Russian (PDF)
- Benefit Highlights H3237-001 - Vietnamese (PDF)
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