Welcome MercyCare Agents…

Please use this page as a hub for access to our benefit summary pages and common forms. Feel free to contact any member of our sales team for additional information.

Thank you for your continued dedication to MercyCare. We look forward to hearing from you.

MYCHART UPDATE- Instructions

**NEW Mercyhealth Rockford Hospital Update**

MCHP List of Contacts for Employer/ Broker Contact-Flyer

Group quote request forms/ Finalizing new group forms

Small group checklist- for agent finalizing new group

Wisconsin:

• WI large group quote request form
• WI small group quote request form
• MercyCare Census Template

Illinois:

• IL large group quote request form
• IL small group quote request form
• MercyCare Census Template

Group forms

• Employer group application WI/ IL
• IL Enrollment application
• WI Enrollment application
• WI Universal application
• IL Universal application
• Change of status
• Waiver of coverage
• Transition of Care Request

Group documents

• MCHP Member Benefit Directory (With Rx)
• Preventive Services
• MercyCare Healthline_Nurse On Call

2019  Group plan grids/ SBC’s/ Summaries

• 2019 Small Group Booklet- WI & IL
• 2019 Small Group Benefit Summaries and SBC’s- WI
• 2019 Small Group Benefit Summaries and SBC’s- IL

2018 Group plan grids/ SBC’s/ Summaries

• 2018 Small Group Booklet- WI & IL
• 2018 Small Group Benefit Summaries and SBC’s- WI
• 2018 Small Group Benefit Summaries and SBC’s- IL

2017 Group plan grids/ SBC’s/ Summaries

• 2017 Small group plans summary sheet- WI
• 2017 Small group plans summary sheet- IL
• 2017 Small Group Benefit Summaries and SBC’s- WI
• 2017 Small Group Benefit Summaries and SBC’s- IL

Certificate’s of Coverage

Large Group and Non-Qualified Health Plans (QHPs)

• Large and Small Group HMO Certificate of Coverage
• Large and Small Group HMO HSA Certificate of Coverage
  • Large Group HMO & HMO HSA Certificate of Coverage Amendments
• Large and Small Group EPO Certificate of Coverage
• Large and Small Group PLUS Certificate of Coverage
  • Large Group Plus Certificate of Coverage Amendments
• Large and Small Group POS Certificate of Coverage
  • Large Group POS Certificate of Coverage Amendments
• Large Group PPO Certificate of Coverage
• Large Group PPO HSA Certificate of Coverage

Individual Health Plans

• Individual Certificate of Coverage- On and Off Exchange

WI-Small Group Qualified Health Plans (QHPs)

• WI Certificate of Coverage – EPO
• WI Certificate of Coverage – HMO
• WI Certificate of Coverage – PPO

IL-Small Group Qualified Health Plans (QHPs)

• IL Certificate of Coverage- HMO off-exchange
• IL Prescription Drug Rider- HMO off exchange

Individual forms  – Submission process

• Individual Application Submission Template (required)
• 2018 Individual Enrollment Application (required)
• Auto Withdrawal Form

Medicare Supplement- Submission process

• Supplement application submission form (required)
• MercyCare senior application (required)
• Auto Withdrawal Form
• Agent Statement (must be  completed by agent and submitted with application at time of submission- required)
• Acknowledgement of Receipt form (required)

Benefits of MercyCare for your clients

• Why choose MercyCare?

When it comes to safeguarding your health, MercyCare gives you access to a network of top Mercyhealth  specialists right here at home. There is no need to drive to Madison. It is easy to get the care you need when you need it, especially when seconds count in a trauma situation. Mercyhealth offers over 150 specialty services that range from the most basic to the highly complex. Right here in your hometown, you will receive the highest standard of care. See for yourself by comparing care in your backyard:

Compare care in your backyard

MercyCare and Mercyhealth are committed to providing quality healthcare and insurance services close to home. MercyCare’s integration with Mercyhealth gives you access to Mercyhealth’s 5 hospitals, 70 medical facilities, and post-acute services(home health services and equipment, and hospice), pharmacies and retail services. As a nationally recognized, vertically integrated health system, Mercyhealth’s 400 primary and specialty care physicians and 4,000 health care professionals will do whatever it takes to keep you well.

Accredited centers of excellence, hospitals and clinics

Another advantage to MercyCare Health Plans is the numerous accredited specialty services available, such as the Level II certified emergency/trauma center, accredited cancer center, accredited chest pain and stroke centers, cardiovascular and pulmonary services, neurosurgery and neuroscience services, cosmetic and plastic surgery, inpatient rehabilitation and more. Our physicians are leaders in their fields, always searching for the most effective diagnosis and treatment options. As a recipient of the Malcolm Baldrige National Quality Award, the nation’s highest presidential honor for quality and organizational excellence, quality care is something MercyCare members can expect from Mercyhealth.