Click here to get a quote and enroll
* Must reside in Rock or Walworth County to be eligible
Open enrollment 2020: November 1-December 15
HEALTH INSURANCE PLANS OFF-MARKETPLACE
Outside of Open Enrollment-Individuals who qualify for special enrollment and are interested in purchasing a health insurance plan off-Marketplace, and directly from MercyCare Health Plans, please download the application below and deliver or mail it to:
MercyCare Health Plans
580 N. Washington St., PO Box 550
Janesville, WI 53547-0550
Individual Enrollment Application
Voluntary Discontinuation of Coverage
Applications, payment and quote provided must be received by the 15th of each month for the upcoming month. If the 15th falls on a holiday or a weekend it must be submitted prior to.
2020
2020 Individual Plan Summaries of Benefits and Coverage
2020 Claims Payment Policies & Other Information
2020 Individual Certificate of Coverage
2019
2019 Individual Plan Summaries of Benefits and Coverage
2019 Claims Payment Policies & Other Information
NOTE: Individuals purchasing insurance off-Marketplace are not eligible for tax credits or any cost-share reductions.
Pediatric dental coverage is not included in off-Marketplace plans. If you would like to purchase pediatric dental coverage, please contact Delta Dental at (800) 236-3713 or visit www.deltadentalcoversme.com.
HOW DO I PAY FOR MY INSURANCE?
MercyCare accepts credit and debit card payments for individual members online. Click here to get started.
MercyCare will bill you for the amount currently due to activate your enrollment. When you receive our invoice, please pay it immediately so that your enrollment can be completed. If you do not receive our invoice within 10 days, please call our customer service department at (800) 895-2421.
Why choose MercyCare?
MercyCare provides quality, affordable health insurance for health care services close to home. We are proud to say that MercyCare as part of Mercyhealth, received the Malcolm Baldrige National Quality Award, the nation’s highest presidential honor for quality and company performance excellence.
MercyCare wants to insure you live well.
Did you know that MercyCare:
- Manages over 40,000 members?
- Is one of the largest HMO plan providers in Rock County?
- Has an open access network, meaning no referrals are needed for in-plan services?
- Contracts with more than 750 medical professionals?
- Has local customer service to assist you including an online chat option?
YOUR HEALTH AND WELLNESS
MercyCare Health Plans links you to Mercyhealth providers and Mercyhealth’s quality health care services such as:
- Heart and vascular care
- Pain management
- Comprehensive cancer care
- Orthopaedic surgery
- Mental health and addictions treatment
- Neurosurgery
- Primary care (family medicine, internal medicine, OB/GYN)
- Complementary medicine
- Trauma services
- Hospice and palliative care
- Lung and sleep medicine
- Plastic surgery
- Men’s and women’s health
KEEP YOUR SAME DOCTOR
If you now use Mercyhealth providers, you can continue your relationship with them. Our private and confidential member website, MercyCareMyPlan.com, allows you to view benefits, claims and eligibility, and communicate with us about ID cards, changing a primary care provider (PCP) and direct questions to customer service representatives.
FAQS
Why should I have health insurance?
- No one plans to get sick or hurt, but most people need medical care at some point. MercyCare Health Plans’ individual plans cover many of your expected and unexpected health care costs and protect you from very high expenses.
- Health insurance is a contract between you and MercyCare Health Plans. You buy a plan that best meets your needs and MercyCare Health Plans pays part of your medical costs when you get sick or hurt.
- There are other important benefits of health insurance. MercyCare Health Plan’s individual plans provide free preventive care, vaccinations, screenings and checkups. We also provide prescription drug coverage.
What is the health insurance Marketplace?
- Also sometimes called the Exchange, the Marketplace is a new way to find health coverage that fits your budget and meets your needs. With one application you can see all your MercyCare Health Plan options and enroll.
- When you use the Marketplace you’ll fill out an application and find out if you can get lower costs on your monthly premiums for private MercyCare insurance plans. You’ll find out if you qualify for lower out-of-pocket costs through Medicaid or the Children’s Health Insurance Program (CHIP).
Can I keep my doctor?
If you currently see a Mercy doctor, you can continue to see him/her by choosing a MercyCare plan. Please note that different plans have different networks and providers. Networks include health care providers that a plan contracts with to take care of the plan’s members. Depending on the type of policy you buy, care may be covered only when you get it from a network provider. When comparing MercyCare plans in the Marketplace, you will see a link to the list of providers in each plan’s network.
What do essential health benefits include?
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative services and devices (to help people with injuries, disabilities or chronic conditions gain or recover their mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Essential health benefits are minimum requirements for all MercyCare plans.
Marketplace Rate Increase Justification
The Centers for Medicare & Medicaid Services (CMS) requires all Qualified Health Plans to post notification on its website explaining why rate increases are necessary for health plans offered on the health insurance marketplace.
Rate increase justifications for MercyCare Health Plans marketplace plans can be found on ratereview.healthcare.gov by selecting Wisconsin, MercyCare Health Plans, and searching the desired date range.
