Plan Benefit Materials | Trillium Advantage

2026 Plan Benefit Materials

Explore your plan and its benefits by reviewing important documents like the Annual Notice of Change (ANOC), Summary of Benefits, and Evidence of Coverage.

To get started, locate your plan in the list of plans below and select “Plan Benefits.”

HMO   |   HMO D-SNP   |  PPO

Wellcare

Wellcare

HMO Plans

Wellcare Low Premium (HMO-POS) H6815-038

Counties: Benton, Clackamas, Columbia, Coos, Douglas, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Annual Notice of Change

  • Annual Notice of Change: Wellcare Simple Value (HMO-POS) H6815-038 to Wellcare Low Premium (HMO-POS) H6815-038 - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare PeaceHealth Simple (HMO-POS) H6815-040

Counties: Lane

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Simple (HMO-POS) H6815-039

Counties: Benton, Clackamas, Columbia, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Back to top

HMO D-SNP Plans

Wellcare Dual Access (HMO-POS D-SNP) H2174-013

Counties: Clackamas, Lane, Multnomah, Washington

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon
  • Annual Notice of Change - Spanish (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon
  • Summary of Benefits - Spanish (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon
  • Evidence of Coverage - Spanish (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon
  • Dental Benefit Details - Spanish (PDF) - Coming Soon

Wellcare Dual Reserve (HMO-POS D-SNP) H2174-012

Counties: Clackamas, Lane, Multnomah, Washington

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon
  • Annual Notice of Change - Spanish (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon
  • Summary of Benefits - Spanish (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon
  • Evidence of Coverage - Spanish (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon
  • Dental Benefit Details - Spanish (PDF) - Coming Soon

 

Wellcare Dual Select Sync (HMO-POS D-SNP) H2174-001

Counties: Clackamas, Lane, Multnomah, Washington

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon
  • Annual Notice of Change - Spanish (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon
  • Summary of Benefits - Spanish (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon
  • Evidence of Coverage - Spanish (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon
  • Dental Benefit Details - Spanish (PDF) - Coming Soon

Back to top

PPO Plans

Wellcare Giveback Open (PPO) H5439-015

Counties: Benton, Clackamas, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Low Premium Open (PPO) H5439-019

Counties: Benton, Clackamas, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Patriot Giveback Open (PPO) H5439-010

Counties: Benton, Clackamas, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Premium Ultra Open (PPO) H5439-011

Counties: Benton, Clackamas, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Simple Open (PPO) H5439-022-001

Counties: Jackson, Josephine

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Simple Open (PPO) H5439-022-002

Counties: Clackamas, Marion, Multnomah, Polk, Washington

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Wellcare Simple Open (PPO) H5439-022-003

Counties: Benton, Douglas, Lane, Linn, Yamhill

Annual Notice of Change

  • Annual Notice of Change - English (PDF) - Coming Soon

Summary of Benefits

  • Summary of Benefits - English (PDF) - Coming Soon

Evidence of Coverage

  • Evidence of Coverage - English (PDF) - Coming Soon

Dental Benefit Details

  • Dental Benefit Details - English (PDF) - Coming Soon

Back to top

Additional Forms

  • Over-the-Counter Catalog (PDF) - Coming Soon
  • Over-the-Counter Catalog and Healthy Food (PDF) - Coming Soon

  • Medicare Step Therapy Part B (PDF) - Coming Soon

  • 2026 Medicare Parts A & B Premiums and Deductibles (PDF) - Coming Soon

  • Member Secure Portal Guide (PDF) - Coming Soon

If you have questions please, contact Member Services.