2020 qualified health plans (QHP)
Small group plan benefit summaries and plan summaries
- HMO full-pay $0 Ded 10255050 Rx – SBC
- HMO full-pay $0 Ded 10255050RX – Summary
- HMO CO 90 $250 Ded 10255050 Rx- SBC
- HMO CO 90 $250 Ded 10255050 Rx- Summary
- HMO Co-80 $500 Ded 10255050 Rx- SBC
- HMO Co-80 $500 Ded 10255050 Rx- Summary
- HMO Co-80 $1,000 Ded 10255050 Rx- SBC
- HMO Co-80 $1,000 Ded 10255050 Rx- Summary
- HMO Co-80 $1,250 Ded 20407550 Rx- SBC
- HMO Co-80 $1,250 Ded 20407550 Rx- Summary
- HMO Co-80 $2,500 Ded 20407550 Rx- SBC
- HMO Co-80 $2,500 Ded 20407550 Rx- Summary
- HMO Co-80 $3,500 Ded 20407550 Rx- SBC
- HMO Co-80 $3,500 Ded 20407550 Rx- Summary
- HMO Co-50 $5,000 Ded 205010050 Rx- SBC
- HMO Co-50 $5,000 Ded 205010050 Rx- Summary
- HMO Co-100 $6,950 Ded. SBC
- HMO Co-100 $6,950 Ded. Summary
- HMO Co-100 $7,500 Ded. SBC
- HMO Co-100 $7,500 Ded. Summary
- HMO Co-100 $8,150 Ded. SBC
- HMO Co-100 $8,150 Ded. Summary
- HMO $2,700 Ded- SBC
- HMO $2,700 Ded- Summary
- HMO HSA $5,000 Ded- SBC
- HMO HSA $5,000 Ded- Summary
- EPO full-pay $0 Ded 10255050 Rx – SBC
- EPO full-pay $0 Ded 10255050 RX -Summary
- EPO CO 90 $250 Ded 10255050 Rx- SBC
- EPO CO 90 $250 Ded 10255050 Rx- Summary
- EPO Co-80 $500 Ded 10255050 Rx- SBC
- EPO Co-80 $500 Ded 10255050 Rx- Summary
- EPO Co-80 $1,000 Ded 10255050 Rx- SBC
- EPO Co-80 $1,000 Ded 10255050 Rx- Summary
- EPO Co-80 $1,250 Ded 20407550 Rx- SBC
- EPO Co-80 $1,250 Ded 20407550 Rx- Summary
- EPO Co-80 $2,500 Ded 20407550 Rx- SBC
- EPO Co-80 $2,500 Ded 20407550 Rx- Summary
- EPO Co-80 $3,500 Ded 20407550 Rx- SBC
- EPO Co-80 $3,500 Ded 20407550 Rx- Summary
- EPO Co-50 $5,000 Ded 205010050 Rx- SBC
- EPO Co-50 $5,000 Ded 205010050 Rx- Summary
- EPO Co-100 $6,950 Ded. SBC
- EPO Co-100 $6,950 Ded. Summary
- EPO Co-100 $7,500 Ded. SBC
- EPO Co-100 $7,500 Ded. Summary
- EPO Co-100 $8,150 Ded. SBC
- EPO Co-100 $8,150 Ded. Summary
- EPO $2,700 Ded- SBC
- EPO $2,700 Ded- Summary
- EPO HSA $5,000 Ded. SBC
- EPO HSA $5,000 Ded Summary
- HMO full-pay $0 Ded 10255050 Rx – SBC
- HMO full-pay $0 Ded 10255050RX – Summary
- HMO CO 90 $250 Ded 10255050 Rx- SBC
- HMO CO 90 $250 Ded 10255050 Rx- Summary
- HMO Co-80 $500 Ded 10255050 Rx- SBC
- HMO Co-80 $500 Ded 10255050 Rx- Summary
- HMO Co-80 $1,000 Ded 10255050 Rx- SBC
- HMO Co-80 $1,000 Ded 10255050 Rx- Summary
- HMO Co-80 $1,250 Ded 20407550 Rx- SBC
- HMO Co-80 $1,250 Ded 20407550 Rx- Summary
- HMO Co-80 $2,500 Ded 20407550 Rx- SBC
- HMO Co-80 $2,500 Ded 20407550 Rx- Summary
- HMO Co-80 $3,500 Ded 20407550 Rx- SBC
- HMO Co-80 $3,500 Ded 20407550 Rx- Summary
- HMO Co-50 $5,000 Ded 205010050 Rx- SBC
- HMO Co-50 $5,000 Ded 205010050 Rx- Summary
- HMO Co-100 $6,950 Ded. SBC
- HMO Co-100 $6,950 Ded. Summary
- HMO Co-100 $7,500 Ded. SBC
- HMO Co-100 $7,500 Ded. Summary
- HMO Co-100 $8,150 Ded. SBC
- HMO Co-100 $8,150 Ded. Summary
- HMO $2,700 Ded- SBC
- HMO $2,700 Ded- Summary
- HMO HSA $5,000 Ded- SBC
- HMO HSA $5,000 Ded- Summary
2019 qualified health plans (QHP)
Small group plan benefit summaries and plan summaries
- HMO full-pay $0 Ded 10255050 Rx – SBC
- HMO full-pay $0 Ded 10255050 Rx – Summary of benefits
- HMO Co-90 $250 Ded 10255050 Rx- SBC
- HMO Co-90 $250 Ded 10255050 Rx– Summary of benefits
- HMO Co-80 $500 Ded 10255050 Rx- SBC
- HMO Co-80 $500 Ded 10255050 Rx– Summary of benefits
- HMO Co-80 $1,000 Ded 10255050 Rx- SBC
- HMO Co-80 $1,000 Ded 10255050 Rx– Summary of benefits
- HMO Co-80 $1,250 Ded 20407550 Rx- SBC
- HMO Co-80 $1,250 Ded 20407550 Rx– Summary of benefits
- HMO Co-80 $2,500 Ded 20407550 Rx- SBC
- HMO Co-80 $2,500 Ded 20407550 Rx– Summary of benefits
- HMO Co-80 $3,500 Ded 20407550 Rx- SBC
- HMO Co-80 $3,500 Ded 20407550 Rx– Summary of benefits
- HMO Co-70 $4,250 Ded 205010050 Rx- SBC
- HMO Co-70 $4,250 Ded 205010050 Rx– Summary of benefits
- HMO Co-50 $5,000 Ded 205010050 Rx- SBC
- HMO Co-50 $5,000 Ded 205010050 Rx- Summary of benefits
- HMO HSA $2,700 Ded- SBC
- HMO HSA $2,700 Ded– Summary of benefits
- HMO HSA $4,000 Ded- SBC
- HMO HSA $4,000 Ded– Summary of benefits
- HMO HSA $5,000 Ded- SBC
- HMO HSA $5,000 Ded– Summary of benefits
- HMO HSA $6,550 Ded- SBC
- HMO HSA $6,550 Ded– Summary of benefits
Uniform glossary
- EPO full-pay $0 Ded 10255050 Rx – SBC
- EPO full-pay $0 Ded 10255050 Rx – Summary of benefits
- EPO Co-90 $250 Ded 10255050 Rx- SBC
- EPO Co-90 $250 Ded 10255050 Rx– Summary of benefits
- EPO Co-80 $500 Ded 10255050 Rx- SBC
- EPO Co-80 $500 Ded 10255050 Rx– Summary of benefits
- EPO Co-80 $1,000 Ded 10255050 Rx- SBC
- EPO Co-80 $1,000 Ded 10255050 Rx– Summary of benefits
- EPO Co-80 $1,250 Ded 20407550 Rx- SBC
- EPO Co-80 $1,250 Ded 20407550 Rx– Summary of benefits
- EPO Co-80 $2,500 Ded 20407550 Rx- SBC
- EPO Co-80 $2,500 Ded 20407550 Rx– Summary of benefits
- EPO Co-80 $3,500 Ded 20407550 Rx- SBC
- EPO Co-80 $3,500 Ded 20407550 Rx– Summary of benefits
- EPO Co-70 $4,250 Ded 205010050 Rx- SBC
- EPO Co-70 $4,250 Ded 205010050 Rx– Summary of benefits
- EPO Co-50 $5,000 Ded 205010050 Rx- SBC
- EPO Co-50 $5,000 Ded 205010050 Rx- Summary of benefits
- EPO HSA $2,700 Ded- SBC
- EPO HSA $2,700 Ded– Summary of benefits
- EPO HSA $4,000 Ded- SBC
- EPO HSA $4,000 Ded– Summary of benefits
- EPO HSA $5,000 Ded- SBC
- EPO HSA $5,000 Ded– Summary of benefits
- EPO HSA $6,550 Ded- SBC
- EPO HSA $6,550 Ded– Summary of benefits
- Uniform glossary
- HMO full-pay $0 Ded 10255050 Rx – SBC
- HMO CO 90 $250 Ded 10255050 Rx- SBC
- HMO Co-80 $500 Ded 10255050 Rx- SBC
- HMO Co-80 $1,000 Ded 10255050 Rx- SBC
- HMO Co-80 $1,250 Ded 20407550 Rx- SBC
- HMO Co-80 $2,500 Ded 20407550 Rx- SBC
- HMO Co-80 $3,500 Ded 20407550 Rx- SBC
- HMO Co-70 $4,250 Ded 205010050 Rx- SBC
- HMO Co-50 $5,000 Ded 205010050 Rx- SBC
- Certificate of Coverage
- Small group booklet: Wisconsin and Illinois
- QHP Formulary 4-tier
- 2019 small group booklet: Wisconsin and Illinois
- QHP Formulary 4-tier
MercyCare HMO Network: Our HMO network includes Mercyhealth providers and contracted providers. Please see map for details.
- Contracted providers: MercyCare contracts with Fort Healthcare, Watertown Regional Medical Center and others to provide healthcare to our members.