Documents and Forms
Here you can find important information regarding the WellSense Medicare Advantage HMO.
Important documents
- Evidence of Coverage
- List of Covered Drugs
- LIS Premium Summary chart
- Provider and Pharmacy directory
- Summary of Benefits
Member forms and information
- Auto Pay Form
- Care Management PHI Authorization Form
- Fitness Reimbursement Form
- Member Rights and Responsibilities
- Prescription Reimbursement Form
Pharmacy Information
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Welcome
Welcome to the new wellsense.org! BMC HealthNet Plan in Massachusetts and Well Sense Health Plan in New Hampshire are now one, unified plan under the name WellSense Health Plan. We’re the same dedicated plan you know—offering the same benefits, provider networks, and prescription drug coverage—with a brand new look and feel. To get started, select your plan from the menu and see information just for you.