Forms and documents

Below you will find many of the forms and documents you may need.  If you don’t see a form or document you need on this page, please click here to contact us.

Forms and Documents

Prescription Drug Claim Forms

*Not all members receive drug plan benefits through MercyCare. If you would like to verify your prescription drug benefits, please contact your employer or MercyCare’s customer service department at (800) 895-2421.

Large Group and Non-Qualified Health Plans (QHPs)

Individual Health Plans

WI-Small Group Qualified Health Plans (QHPs)

IL-Small Group Qualified Health Plans (QHPs)