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Business Forms & Documents

These forms and documents explain how to complete the application process and make changes to your existing coverage:

  • Employer group application (Large and Small) WI
  • Employer group application(Large) IL
  • Employer group application(Small) IL
  • IL Enrollment application
  • WI Enrollment application- FILLABLE VERSION
  • Change of status – FILLABLE VERSION
  • Member benefit directory
  • Coordination of Benefits
  • Auto Withdrawal Form FILLABLE VERSION
  • Employer Handbook- Administrative Guide
  • Provider Appeal Form

If you have any questions regarding the forms and documents listed here, please call MercyCare Health Plans at (800) 895-2421.

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