Documents-Forms

• HMO Certificate of Coverage
• PPO Certificate of Coverage
• 3-tier formulary
• Prescription drug benefit request form
• Medical benefit drug request form
• Stay Healthy Form

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Compare care in your backyard

MercyCare’s local customer service and sales staff are here where you work and live, to provide the answers to your health care questions. Call (800) 895-2421 today.

Health, wellness and preventive care

MercyCare staff is certified in disease and case management to help members manage chronic diseases such as asthma, diabetes and chronic kidney disease. For more information click here.

In fact, MercyCare has received a multitude of recognitions including our diabetes case management program receiving national recognition for working to improve individual health outcomes.

Request more information by completing our form below or call (800) 895-2421.