- Summary of Benefits and Coverage/ Plan Benefit Documents
- Uniform Glossary
- Stay Healthy Reimbursement Form
Select your network:
- Mercyhealth Partners EPO or EPO HDHP-T3
- Mercyhealth Partners PPO or PPO HDHP T8
- Find a pharmacy
- Pharmacy claim information
- Drug information
- Drug pricing
- Medical condition information
- Copay information
- Explanation of benefits for prescription drug benefits
- Drug spend amount for prescription drug benefits
Two-tiered drug plan
This drug plan has an extensive list of covered prescription medications divided into two tiers. Tier-1 is the lowest co-pay level and includes preferred generics and over-the-counter medications. Tier-2 is the higher co-pay level and includes preferred brands. All medications listed in the formulary have been reviewed for safety and effectiveness and are chosen by a committee of physicians and pharmacists.
Four-tiered drug plan
This four-tiered drug plan incorporates four levels of benefits. Tier 1 is for preferred generic drugs, preferred tier 1 brand name drugs, and covered over-the-counter (OTC) drugs, and has the lowest co-payment. Tier 2 covers selected generic drugs and our preferred tier 2 brand name drugs, and has the second lowest co-payment. Tier 3 represents all non-preferred drugs, except specialty drugs, and has the third lowest co-payment. Tier 4 covers only selected generic drugs, selected brand name drugs, specialty drugs, and clinically-appropriate non-covered drugs by approval, and has the highest co-payment. This drug plan is a closed formulary, which means that only those drugs listed in the formulary are available to our members. All medications listed in the formulary are reviewed for safety and effectiveness and chosen by a committee of physicians and pharmacists. Other changes may occur to this formulary as determined by MercyCare.
- A health risk assessment (HRA) is a short, confidential survey designed to assess your true health status
MercyCare Health Plans Contact Information
580 N. Washington St.
PO Box 550
Janesville, WI 53547-0550
Customer Service: (800) 895-2421, M-F 8:00 am-4:30 pm