24-751m 2024 Medicare and Medicare DSNP Plan Codes with Plan Name and Service Area
Date: 07/11/24
Review the ‘H’ contract number, plan benefit package (PBP) and plan codes for each service area
Individual Wellcare By Health Net (Health Net) plan codes, county availability and Centers for Medicare & Medicaid Services contract identification numbers are provided in the table below. Use the plan code information to identify DSNP members and their counties.
2024 H contract & PBP | 2024 Plan name | Service area | 2024 Plan codes |
H0562-009 | Wellcare Premium Ultra (HMO) | Amador, Placer, Sacramento, | KOR |
H0562-012 | Wellcare No Premium Focus (HMO) | Imperial, San Diego | KOS |
H0562-039 | Wellcare Premium Ultra (HMO) | Yolo | KOT |
H0562-079 | Wellcare No Premium Ruby (HMO) | Fresno, Kern, Madera, Stanislaus, Tulare | KOU |
H0562-092 | Wellcare Specialty No Premium (HMO C-SNP) | Kern, Los Angeles, Orange, San Diego | KOW |
H0562-097 | Wellcare No Premium Focus (HMO) | San Francisco | KOX |
H0562-125 | Wellcare No Premium Focus (HMO) | Los Angeles, Orange | KP6 |
H0562-126 | Wellcare No Premium Focus (HMO) | Riverside, San Bernardino | KP7 |
H0562-128 | Wellcare No Premium (HMO) | Amador, San Mateo, Santa Clara, Solano, Yolo | KP8 |
H0562-130-001 | Wellcare Low Premium (HMO) | Los Angeles, Orange | KP4 |
H0562-130-002 | Wellcare Low Premium (HMO) | Imperial, Riverside, San Bernardino, | KP5 |
H3561-001 | Wellcare Dual Liberty (HMO D-SNP) | Amador, Imperial, Kern, Placer, | KPC |
H3561-007 | Wellcare CalViva Health Dual Align (HMO D-SNP) | Fresno, Kings, Madera | KPD |
H3561-008 | Wellcare Dual Align (HMO D-SNP) | Los Angeles, Sacramento, Tulare | KPE |
H3561-009 | Wellcare Dual Liberty (HMO D-SNP) | Orange, Riverside, San Bernardino, | KP3 |
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone at 800-929-9224 or through the Health Net provider portal. Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.