Silver
- Silver Option A Limited Cost Share 58326WI0090002-03
- Silver Standard Limited Cost Share 58326WI0090022-03
- Silver HDHP Limited Cost Share 58326WI0090016-03
Must reside in Rock or Walworth Counties to be eligible.
2023 plan information
Individual/family plan summaries of benefits and coverage: Wisconsin
Gold
- 2023 Individual/family booklet
- 2023 Formulary
- 2023 Certificate of Coverage
- 2023 Claims payment policies and other information
2022 plan information
Individual/family plan summaries of benefits and coverage: Wisconsin
Gold
- Gold Option A 58326WI0090001-00 & 58326WI0090001-01
- Gold Option B 58326WI0090012-00 & 58326WI0090012-01
- Gold Option C 58326WI0090013-00 & 58326WI0090013-01
Silver
- Silver Option A 58326WI0090002-00& 58326WI0090002-01
- Silver Option B 58326WI0090015-00 & 58326WI0090015-01
- Silver Option C 58326WI0090016-00 & 58326WI0090016-01
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Summaries of benefits and coverage: Only available on Exchange
Gold
- Gold Option A Limited Cost Share Plan 58326WI0090001-03
- Gold Option B Limited Cost Share Plan 58326WI0090012-03
- Gold Option C Limited Cost Share Plan 58326WI0090013-03
Silver
- Silver Option A Limited Cost Share Plan 58326WI0090002-03
- Silver Option B Limited Cost Share Plan 58326WI0090015-03
- Silver Option C Limited Cost Share Plan 58326WI0090016-03
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Summaries of benefits and coverage: Only available on Exchange
Gold
- Gold Option A Zero Cost Share Plan 58326WI0090001-02
- Gold Option B Zero Cost Share Plan 58326WI0090012-02
- Gold Option C Zero Cost Share Plan 58326WI0090013-02
Silver
- Silver Option A Zero Cost Share Plan 58326WI0090002-02
- Silver Option B Zero Cost Share Plan 58326WI0090015-02
- Silver Option C Zero Cost Share Plan 58326WI0090016-02
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Additional documents
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.